Individual
WAYNE M CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
8810A FARROW RD, COLUMBIA, SC 29203-8802
(803) 741-2010
(803) 741-2011
Mailing address
8810A FARROW RD, COLUMBIA, SC 29203-8802
(803) 741-2010
(803) 741-2011
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
442
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D04424
—
SC
Enumeration date
02/22/2006
Last updated
11/04/2015
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