Individual
MARIA SHIELDS DICKERSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1007 KINCAID BRIDGE RD, WINNSBORO, SC 29180-7113
(803) 635-6496
(803) 635-6932
Mailing address
104 ODELL ST, WHITMIRE, SC 29178-1117
(803) 694-4724
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1336
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D13368
—
SC
Enumeration date
05/18/2006
Last updated
07/08/2007
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