Provider Demographics
NPI:1760442651
Name:ROCKWELL, JEFFREY C (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:ROCKWELL
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:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-1206
Mailing Address - Country:US
Mailing Address - Phone:864-229-2301
Mailing Address - Fax:864-229-1898
Practice Address - Street 1:711 MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1440
Practice Address - Country:US
Practice Address - Phone:864-229-2301
Practice Address - Fax:864-229-1898
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05634Medicaid
SC5200850001Medicare NSC
SCD05634Medicaid