Provider Demographics
NPI:1841317724
Name:KONDOR, JAMES D (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:KONDOR
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 1:10 HOSPITAL CENTER CMNS
Mailing Address - Street 2:STE. 100
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2839
Mailing Address - Country:US
Mailing Address - Phone:843-681-6682
Mailing Address - Fax:843-681-9582
Practice Address - Street 1:10 HOSPITAL CENTER CMNS
Practice Address - Street 2:STE. 100
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2839
Practice Address - Country:US
Practice Address - Phone:843-681-6682
Practice Address - Fax:843-681-9582
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1841317724Medicaid
SCT928860381Medicare PIN
SCT92886Medicare UPIN
SC0279780001Medicare NSC
SCT928863063Medicare PIN