Provider Demographics
NPI:1922061209
Name:NASH, KENNETH MACK (O D)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MACK
Last Name:NASH
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MAIN ST
Mailing Address - Street 2:PO BOX 1035
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3230
Mailing Address - Country:US
Mailing Address - Phone:864-388-2020
Mailing Address - Fax:864-229-5573
Practice Address - Street 1:1001 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3230
Practice Address - Country:US
Practice Address - Phone:864-388-2020
Practice Address - Fax:864-229-5573
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05536Medicaid
SCT237154761Medicare UPIN