Individual
JACOB DAVID MACDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
7800 RIVERS AVE, NORTH CHARLESTON, SC 29406-4057
(843) 572-3404
Mailing address
2611 RANGER DR, NORTH CHARLESTON, SC 29405-7391
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1989
SC
Other
Enumeration date
06/01/2017
Last updated
06/01/2017
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