MEDICARE: DR. DAVID H MCKENZIE JR. O.D.

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	1143	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CJ7222	OTHER	SC	RAILROAD MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4508790001	OTHER	SC	PALMETTO GBA #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962511592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID H MCKENZIE JR. O.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. DAVID H MCKENZIE JR. O.D.” Practice Location

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