Provider Demographics
NPI:1689667016
Name:KOETS, DONALD JOE (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOE
Last Name:KOETS
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 1:206 E 2ND NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6858
Mailing Address - Country:US
Mailing Address - Phone:843-851-1037
Mailing Address - Fax:843-851-1392
Practice Address - Street 1:206 E 2ND NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6858
Practice Address - Country:US
Practice Address - Phone:843-851-1037
Practice Address - Fax:843-851-1392
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC014055OtherAOA
SCDO4975Medicaid
SCDO4975Medicaid
SC014055OtherAOA
T25055Medicare UPIN