MEDICARE: DAVID H MCKENZIE JR OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4508790001	OTHER	SC	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881817526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID H MCKENZIE JR OD INC

Provider Business Mailing Address
First Line	:	2010 BROWNING GATE RD
Second Line	:	PO BOX 398
City	:	ESTILL
State	:	SC
Zip	:	29918-2428
Country	:	US
Telephone Number	:	803-625-3384
Fax Number	:	803-625-3579

Provider Business Practice Location Address
First Line	:	2010 BROWNING GATE RD
Second Line	:
City	:	ESTILL
State	:	SC
Zip	:	29918-2428
Country	:	US
Telephone Number	:	803-625-3384
Fax Number	:	803-625-3579

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID H MCKENZIE JR.
Credential	:	OD
Telephone Number	:	803-625-3384

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	10/09/2007

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