Provider Demographics
NPI:1750595690
Name:DRS KELLEY & MCDOWELL PA
Entity type:Organization
Organization Name:DRS KELLEY & MCDOWELL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JEFFERSON
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:803-475-6075
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067
Mailing Address - Country:US
Mailing Address - Phone:803-475-6075
Mailing Address - Fax:803-475-6077
Practice Address - Street 1:112 EAST HILTON ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067
Practice Address - Country:US
Practice Address - Phone:803-475-6075
Practice Address - Fax:803-475-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC613152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC427693Medicaid
SC0536540001Medicare NSC
T24821Medicare UPIN
SC1572Medicare PIN