Organization
JACKSON DAVENPORT VISION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH RICHARD DAVENPORT II (PRESIDENT)
(843) 871-9750
Entity
Organization
Contact information
Practice address
218 OLD TROLLEY RD, SUMMERVILLE, SC 29485-4929
(843) 871-9750
(843) 873-6197
Mailing address
218 OLD TROLLEY RD, SUMMERVILLE, SC 29485-4929
(843) 871-9750
(843) 873-6197
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
589
SC
152W00000X
Optometrist
Primary
—
—
156FX1800X
Optician
686
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DA9858
—
SC
Enumeration date
10/04/2006
Last updated
08/07/2023
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