Jackson Davenport Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

509 Issued in SC

Legal business name

JACKSON DAVENPORT INC.

Practice address

379 King St
Charleston, SC 29401-1438

Phone

(843) 722-4416

Fax

(843) 720-8984

NPI assigned

Nov 21, 2006

Last updated

Jul 16, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Nancy Watkins Davenport

Title

Manager

Phone

(843) 722-4416

Specialties & licenses 4

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405468800000",
    "number": "1073688602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20236",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294130236",
            "telephone_number": "843-722-4416",
            "fax_number": "843-720-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "379 KING ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294011438",
            "telephone_number": "843-722-4416",
            "fax_number": "843-720-8984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON DAVENPORT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2014-07-16",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "WATKINS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "843-722-4416",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "509",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "SC",
            "license": "509",
            "primary": false
        },
        {
            "code": "156FC0801X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Contact Lens Fitter",
            "state": "SC",
            "license": "152",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "SC",
            "license": "501",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CHOICE",
            "identifier": "62167",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9859",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric Jablon, M.D.
• Mary Jo Jack, RPH
• Anna Jacks, MD
• Mariah Kay Jacks, PA-C
• Jackson Ard Vision Center
• Abigail Jackson, DMD
• Aisha Abeo Jackson, M.D.
• Amy Jackson, MA
• Ansley Jackson, LISW-CP
• Bakari Jackson

• Optometrist in Charleston, SC
• Providers in Charleston, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.