Provider Demographics
NPI:1851447932
Name:MCDOWELL, JAMES JEFFERSON JR (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JEFFERSON
Last Name:MCDOWELL
Suffix:JR
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 98
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067
Mailing Address - Country:US
Mailing Address - Phone:803-475-6075
Mailing Address - Fax:803-475-6077
Practice Address - Street 1:112 EAST HILTON ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067
Practice Address - Country:US
Practice Address - Phone:803-475-6075
Practice Address - Fax:803-475-6077
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC613152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC427693Medicaid
0536540001Medicare NSC
T24821Medicare UPIN
1572Medicare ID - Type Unspecified