NPIMap

Organization Active NPI

Trident Low Vision Specialties, LLC

  • Health Service Clinic/Center
  • Ladson, SC
National Provider Identifier
1619163391
Registry record updated Sep 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
1474 Issued in SC
Legal business name
TRIDENT LOW VISION SPECIALTIES, LLC
Practice address
9565 Highway 78
Building 300
Ladson, SC 29456
Phone
(843) 412-2339
NPI assigned
Sep 17, 2007
Last updated
Sep 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2007

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

Authorized official

Name
Dr. Nacondus Grayson Gamble, OD
Title
Optometrist
Phone
(843) 601-0567

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 1474 SC Primary

Addresses

Primary practice location

9565 Highway 78
Building 300
Ladson, SC 29456

Mailing address

1994 Pine Ridge Cir
Apt 422
North Charleston, SC 29405-6435
Phone (843) 601-0567

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189987200000",
    "number": "1619163391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1994 PINE RIDGE CIR",
            "address_2": "APT 422",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294056435",
            "telephone_number": "843-601-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9565 HIGHWAY 78",
            "address_2": "BUILDING 300",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "29456",
            "telephone_number": "843-412-2339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT LOW VISION SPECIALTIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-17",
        "last_updated": "2007-09-17",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "NACONDUS",
        "authorized_official_middle_name": "GRAYSON",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "843-601-0567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "SC",
            "license": "1474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ladson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2007; 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.