Active NPI
Dehaven Preston Taylor, LDO
- Optician
- Moncks Corner, SC
National Provider Identifier
1194457358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 1207
- Practice address
- 511 N Highway 52
Moncks Corner, SC 29461-3132 - Phone
- (843) 899-5872
- Fax
- (843) 899-5875
- NPI assigned
- Jun 27, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 1207 | SC | Primary |
Addresses
Primary practice location
511 N Highway 52
Moncks Corner, SC 29461-3132
Mailing address
511 N Highway 52
Moncks Corner, SC 29461-3132
Phone (843) 899-5872
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1207 | SC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656288000000",
"number": "1194457358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 N HIGHWAY 52",
"city": "MONCKS CORNER",
"state": "SC",
"postal_code": "294613132",
"telephone_number": "843-899-5872",
"fax_number": "843-899-5875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 N HIGHWAY 52",
"city": "MONCKS CORNER",
"state": "SC",
"postal_code": "294613132",
"telephone_number": "843-899-5872",
"fax_number": "843-899-5875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR",
"first_name": "DEHAVEN",
"middle_name": "PRESTON",
"credential": "LDO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-27",
"last_updated": "2022-06-27",
"certification_date": "2022-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "SC",
"license": "1207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moncks Corner, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.