Provider Demographics
NPI:1417186495
Name:MCNEELY, JOHNDRA UPTON (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHNDRA
Middle Name:UPTON
Last Name:MCNEELY
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 1:1212 HAYWOOD RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2200
Mailing Address - Country:US
Mailing Address - Phone:864-234-7700
Mailing Address - Fax:
Practice Address - Street 1:1212 HAYWOOD RD
Practice Address - Street 2:SUITE 600
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2200
Practice Address - Country:US
Practice Address - Phone:864-234-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist