Provider Demographics
NPI:1962511592
Name:MCKENZIE, DAVID H JR (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:MCKENZIE
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 1:2010 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4508790001OtherPALMETTO GBA #
SCCJ7222OtherRAILROAD MEDICARE #
SCD11431Medicaid
SCDA9763Medicaid
SCD11431Medicaid