DRS Kelley & McDowell PA – Optometrist in Kershaw, SC

Key facts

NPI: 1750595690
Entity type: Organization (NPI type 2)
Primary specialty: Optometrist 152W00000X
License: 613 (SC)
Legal business name: DRS KELLEY & MCDOWELL PA
Practice address: 112 East Hilton St
Kershaw, SC 29067
Phone: (803) 475-6075
Fax: (803) 475-6077
NPI assigned: May 10, 2007
Organization subpart: No

Authorized official

Name: James Jefferson McDowell Jr., OD NPI 1851447932
Title: Optometrist
Phone: (803) 475-6075

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

James Jefferson McDowell Jr., OD Optometrist · Kershaw, SC · NPI 1851447932

Medicare reassignment NPD Authorized official OPTOMETRIST · SC

Medicare participation

Medicare fee-for-service enrollment: Enrolled in SC

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20071217000000	SC	Part B Supplier - Clinic/Group Practice	9931299856	Receives reassigned benefits from 1 practitioner Practice locations: Kershaw, SC

National Provider Directory

Locations

112 E Hilton St
Kershaw, SC 29067
Phone (803) 475-6075

217 N Pearl St
Pageland, SC 29728
Phone (843) 672-7233

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist Group: 193200000X MULTI-SPECIALTY GROUP	152W00000X	613	SC	Yes

Addresses

Primary practice location

112 East Hilton St
Kershaw, SC 29067

Mailing address

PO Box 98
Kershaw, SC 29067
Phone (803) 475-6075

Other identifiers

Identifier	Type	State	Issuer
427693	Medicaid	SC

Other providers in Kershaw, SC

All providers in Kershaw, SC · Optometrist in South Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.