Individual
TYVON JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
237 BROOK PINES DR APT 11111, COLUMBIA, SC 29210-0511
(843) 617-0997
Mailing address
237 BROOK PINES DR APT 11111, COLUMBIA, SC 29210-0511
(843) 617-0997
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1239
SC
Other
Enumeration date
11/11/2021
Last updated
11/11/2021
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