NPIMap

Organization Active NPI

Jackson Davenport Vision Services , LLC

Doing business as Jackson Davnport Vision Center

  • Optometrist
  • Summerville, SC
National Provider Identifier
1881197648
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1815 Issued in SC
Legal business name
JACKSON DAVENPORT VISION SERVICES , LLC
Doing business as
Jackson Davnport Vision Center
Practice address
101 Old Trolley Rd
Summerville, SC 29485-4908
Phone
(843) 871-9750
Fax
(843) 873-6797
NPI assigned
Mar 17, 2018
Last updated
Jul 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Authorized official

Name
Mr. Kenneth Richard Davenport II
Title
Managing Partner
Phone
(843) 871-9750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1815 SC Primary

Addresses

Primary practice location

101 Old Trolley Rd
Summerville, SC 29485-4908

Mailing address

218 Old Trolley Rd
Summerville, SC 29485-4929
Phone (843) 871-9750

Other names 1

  • Jackson Davnport Vision Center Doing business as

National Provider Directory

National Provider Directory

Locations

218 Old Trolley Rd
Summerville, SC 29485
Phone (843) 871-9750

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1521244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690502400000",
    "number": "1881197648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 OLD TROLLEY RD",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294854929",
            "telephone_number": "843-871-9750",
            "fax_number": "843-873-6797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 OLD TROLLEY RD",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294854908",
            "telephone_number": "843-871-9750",
            "fax_number": "843-873-6797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON DAVENPORT VISION SERVICES , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-17",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "843-871-9750",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Davnport Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.