Provider Demographics
NPI:1740612506
Name:SEXTON, MEGAN MARIE (OD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:SEXTON
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 1:2750 JOBEE DR APT 8
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6529
Mailing Address - Country:US
Mailing Address - Phone:843-708-8413
Mailing Address - Fax:
Practice Address - Street 1:1470 TOBIAS GADSON BLVD STE 115
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4835
Practice Address - Country:US
Practice Address - Phone:843-556-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist