Organization
JACKSON DAVENPORT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY WATKINS DAVENPORT (MANAGER)
(843) 722-4416
Entity
Organization
Contact information
Practice address
379 KING ST, CHARLESTON, SC 29401-1438
(843) 722-4416
(843) 720-8984
Mailing address
PO BOX 20236, CHARLESTON, SC 29413-0236
(843) 722-4416
(843) 720-8984
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
509
SC
152WC0802X
Corneal and Contact Management Optometrist
509
SC
156FC0801X
Contact Lens Fitter
152
SC
156FX1800X
Optician
501
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62167
FIRST CHOICE
SC
05
—
DA9859
—
SC
Enumeration date
11/21/2006
Last updated
07/16/2014
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