Individual
JESSE MICHAEL WILLINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
717 OLD TROLLEY RD STE 3, SUMMERVILLE, SC 29485-5287
(843) 873-1889
Mailing address
1816 SUCCESS ST STE 101, NORTH CHARLESTON, SC 29405-7851
(843) 203-0200
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT.2201
SC
152W00000X
Optometrist
TUV008748
NY
Other
Enumeration date
06/08/2018
Last updated
01/12/2023
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