| |
4592 Jefferson Davis Hwy, Beech Island, SC 29842-4872 | |
(803) 593-4508 | |
(803) 593-4504 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 4592 Jefferson Davis Hwy, Beech Island, South Carolina |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1508921495 | NPI | - | NPPES |
DA9892 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 974 (South Carolina) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 280, Clearwater, SC 29822-0280 Ph: (803) 593-4508 | 4592 Jefferson Davis Hwy, Beech Island, SC 29842-4872 Ph: (803) 593-4508 |
Dr. Judith Hendrickson, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 4592 Jefferson Davis Hwy, Beech Island, SC 29842 Phone: 803-593-4508 Fax: 803-593-4504 |