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Contact Information

JACKSON DAVENPORT INC.
379 KING ST
CHARLESTON, SC29401-1438
 Phone: 843-722-4416
 Fax: 843-720-8984
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Contact Lens Fitter

156FC0801X
 

Corneal and Contact Management

152WC0802X 41 Optometry
 

Optician

156FX1800X 96[5] Optician
Indicates primary specialty

NPI Profile & details for JACKSON DAVENPORT INC.

NPI Number 1073688602
LBN Legal business name JACKSON DAVENPORT INC.
Authorized official NANCY DAVENPORT - (MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/21/2006
Last updated 07/16/2014 - About 12 years ago
Identifiers
SC License # 152
SC License # 501
SC License # 509
SC Medicaid DA9859
SC Other 62167 FIRST CHOICE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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