Individual
DR. JUSTINE SIEGERS PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
121 LUCY LN, COLUMBIA, SC 29229-7835
(803) 217-2550
(803) 217-2548
Mailing address
PO BOX 1107, IRMO, SC 29063
(803) 781-2123
(803) 749-0183
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1603
SC
152WC0802X
Corneal and Contact Management Optometrist
SC1603
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SC1603
OPTOMETRIST LICENSE
SC
Enumeration date
07/13/2010
Last updated
01/29/2025
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