Provider Demographics
NPI:1073602421
Name:KEGEL, KATHERINE JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JAMES
Last Name:KEGEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9426
Mailing Address - Country:US
Mailing Address - Phone:843-568-1602
Mailing Address - Fax:
Practice Address - Street 1:1929 OAK TREE LN
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9426
Practice Address - Country:US
Practice Address - Phone:843-568-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1193152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD11930Medicaid