Healthcare Provider Details

I. General information

NPI: 1295819746
Provider Name (Legal Business Name): RONALD L MORRIS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 KNOX ABBOTT DRIVE
CAYCE SC
29033-4127
US

IV. Provider business mailing address

600 KNOX ABBOTT DRIVE
CAYCE SC
29033-4127
US

V. Phone/Fax

Practice location:
  • Phone: 803-794-4444
  • Fax: 803-794-2085
Mailing address:
  • Phone: 803-794-4444
  • Fax: 803-794-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1249
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: