Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1823 | SC |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1823 | SC |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 1823 | SC |
N | 152WP0200X | Pediatric Optomitrist | 1823 | SC |
N | 152WV0400X | Optomitrist - Vision Therapist | 1823 | SC |
NPI | 1003220138 |
---|---|
Provider Name | Dr. Justine J O'dell |
First Address | Taylors, SC 29687-4149 |
Second Address | Spartanburg, SC 29301-2631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 26/01/2017 |