Provider Demographics
NPI:1659364826
Name:POCKL, JEFFREY STEPHEN (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEPHEN
Last Name:POCKL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2536
Mailing Address - Country:US
Mailing Address - Phone:803-758-0058
Mailing Address - Fax:
Practice Address - Street 1:2900B DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1842
Practice Address - Country:US
Practice Address - Phone:803-376-4545
Practice Address - Fax:803-254-2324
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10539Medicaid
SCD10539Medicaid