Provider Demographics
NPI:1255520201
Name:RHODES, JAMES LEON (OPTICIAN)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEON
Last Name:RHODES
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6173
Mailing Address - Country:US
Mailing Address - Phone:843-665-1100
Mailing Address - Fax:843-665-1100
Practice Address - Street 1:1955 2ND LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6173
Practice Address - Country:US
Practice Address - Phone:843-665-1100
Practice Address - Fax:843-665-1100
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC292156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0623200001Medicare PIN