Individual provider Active NPI

Kenneth Mack Nash, O D

  • Optometrist
  • Greenwood, SC
National Provider Identifier
1922061209
Registry record updated Nov 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
553 Issued in SC
Practice address
1001 S Main St
Greenwood, SC 29646-3230
Phone
(864) 388-2020
Fax
(864) 229-5573
NPI assigned
Apr 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 553 SC Primary

Addresses

Primary practice location

1001 S Main St
Greenwood, SC 29646-3230

Mailing address

1001 S Main St
PO Box 1035
Greenwood, SC 29646-3230
Phone (864) 388-2020

Other identifiers 1

IdentifierTypeStateIssuer
D05536MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101004001124 SC Practitioner - Optometry 2466565940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clark Optometric Center of SC P.a.Group PAC ID 0446596274, 6 clinicians

Practice addresses (Care Compare)

1001 Main St S
Greenwood, SC 29646-3230
Phone (864) 388-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
553SCMDSchool Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Clark Optometric Center of SC, P.a. Optometrist CurrentSince Apr 1, 2019 Accepting new patients

Locations

1829 Doctors Dr
Sanford, NC 27330
Phone (919) 776-2032

1001 Main St S
Greenwood, SC 29646
Phone (864) 223-1960

479 Bypass 72 NW
Ste 107
Greenwood, SC 29649
Phone (864) 388-2020

419 SE Main St
Ste 300
Simpsonville, SC 29681
Phone (864) 417-2345

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1922061209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 S MAIN ST",
            "address_2": "PO BOX 1035",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463230",
            "telephone_number": "864-388-2020",
            "fax_number": "864-229-5573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S MAIN ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463230",
            "telephone_number": "864-388-2020",
            "fax_number": "864-229-5573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASH",
        "first_name": "KENNETH",
        "middle_name": "MACK",
        "name_prefix": "Dr.",
        "credential": "O D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-08",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D05536",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.