Provider Demographics
NPI:1588854814
Name:JAMES, ALEQUE STEGALL (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEQUE
Middle Name:STEGALL
Last Name:JAMES
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:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-0745
Mailing Address - Country:US
Mailing Address - Phone:803-628-5477
Mailing Address - Fax:803-628-5474
Practice Address - Street 1:46 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1529
Practice Address - Country:US
Practice Address - Phone:803-628-5477
Practice Address - Fax:803-628-5474
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD14777Medicaid
SC0560980002Medicare NSC
SCAA35508687Medicare PIN
SCAA3550Medicare UPIN