Provider Demographics
NPI:1760449003
Name:STECK, KERRY R (OD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:R
Last Name:STECK
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 1:317 THE PKWY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4569
Mailing Address - Country:US
Mailing Address - Phone:864-627-0634
Mailing Address - Fax:864-627-1960
Practice Address - Street 1:317 THE PKWY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4569
Practice Address - Country:US
Practice Address - Phone:864-627-0634
Practice Address - Fax:864-627-1960
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC945152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD09453Medicaid
SC374622412OtherBLUE CROSS BLUE SHIELD
SC4577752OtherAETNA
SCU030184472Medicare ID - Type Unspecified
SCD09453Medicaid