Provider Demographics
NPI:1881817526
Name:DAVID H MCKENZIE JR OD INC
Entity Type:Organization
Organization Name:DAVID H MCKENZIE JR OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:803-625-3384
Mailing Address - Street 1:2010 BROWNING GATE RD
Mailing Address - Street 2:PO BOX 398
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-2428
Mailing Address - Country:US
Mailing Address - Phone:803-625-3384
Mailing Address - Fax:803-625-3579
Practice Address - Street 1:2010 BROWNING GATE RD
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-2428
Practice Address - Country:US
Practice Address - Phone:803-625-3384
Practice Address - Fax:803-625-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4508790001OtherMEDICARE DME
SCDA9763Medicaid
SC7252Medicare ID - Type UnspecifiedMEDICARE GROUP #