Kevin Paul Elliott, LDO VCM

Primary specialty

OpticianTaxonomy code 156FX1800X

License

SC464 Issued in SC

Practice address

175 Highway 274
Lake Wylie, SC 29710-6045

Phone

(803) 619-7025

Fax

(803) 831-5049

NPI assigned

Jun 15, 2022

Last updated

Jun 15, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1356071070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 HIGHWAY 274",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297106045",
            "telephone_number": "803-619-7025",
            "fax_number": "803-831-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 HIGHWAY 274",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297106045",
            "telephone_number": "803-619-7025",
            "fax_number": "803-831-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "KEVIN",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "LDO VCM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-15",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "SC",
            "license": "SC464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optician in Lake Wylie, SC
• Providers in Lake Wylie, SC by specialty
• Optician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.

Verify at the official NPI Registry.