Individual
DONALD WALTER INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
1636 REVOLUTIONARY DR, SENECA, SC 29672
(864) 885-9075
Mailing address
1636 SANDIFER BLVD, SENECA, SC 29678-0906
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
801
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
601
—
SC
01
—
801
LICENSE
SC
05
—
801
—
SC
Enumeration date
07/08/2022
Last updated
07/08/2022
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