Provider Demographics
NPI:1598768913
Name:MCMEEKIN, MARVIN S (OD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:S
Last Name:MCMEEKIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:STAN
Other - Middle Name:
Other - Last Name:MCMEEKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:16 FERNWALK PL
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4603
Mailing Address - Country:US
Mailing Address - Phone:864-268-4204
Mailing Address - Fax:864-268-4244
Practice Address - Street 1:2411 HUDSON RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2923
Practice Address - Country:US
Practice Address - Phone:864-268-4204
Practice Address - Fax:864-268-4244
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-819-TA-183152W00000X
SC1046152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10469Medicaid
SCU58648Medicare UPIN