Provider Demographics
NPI:1760113112
Name:O'NEAL, PAMELA VENTRESS
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:VENTRESS
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ROBERT SMALLS PKWY
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-4284
Mailing Address - Country:US
Mailing Address - Phone:843-521-1679
Mailing Address - Fax:843-521-3085
Practice Address - Street 1:350 ROBERT SMALLS PKWY
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-4284
Practice Address - Country:US
Practice Address - Phone:843-521-1679
Practice Address - Fax:843-521-3085
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1306156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician