Provider Demographics
NPI:1720080971
Name:POSTON, JERD WATTS (OD)
Entity Type:Individual
Prefix:
First Name:JERD
Middle Name:WATTS
Last Name:POSTON
Suffix:
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 15790
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587-5790
Mailing Address - Country:US
Mailing Address - Phone:843-650-2400
Mailing Address - Fax:843-650-2525
Practice Address - Street 1:1651 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4836
Practice Address - Country:US
Practice Address - Phone:843-650-2400
Practice Address - Fax:843-650-2525
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO6946Medicaid
SCT23842Medicare UPIN