Michelle Marie McKenzie, OD
Individual provider Active NPI Optometrist · Estill, SC
NPI 1821182452 · NPPES record last updated Mar 31, 2011
Key facts
- NPI
- 1821182452
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1187 (SC)
- Practice address
- 2010 Browning Gate Road
Estill, SC 29918 - Phone
- (803) 625-3384
- Fax
- (803) 625-3579
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1187 | SC | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David H McKenzie Jr OD Inc | Optometrist | Past |
Accepting new patients |
| Dr John Janvier & Associates PC | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1187 | SC | Yes |
Addresses
Primary practice location
2010 Browning Gate Road
Estill, SC 29918
Mailing address
2010 Browning Gate Road
PO Box 398
Estill, SC 29918
Phone (803) 625-3384
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D11878 | Medicaid | SC |
Other providers in Estill, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.