Healthcare Provider Details

I. General information

NPI: 1487707881
Provider Name (Legal Business Name): JACKSON ARD VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SAVANNAH HWY
CHARLESTON SC
29407-7859
US

IV. Provider business mailing address

PO BOX 31919
CHARLESTON SC
29417-1919
US

V. Phone/Fax

Practice location:
  • Phone: 843-166-7753
  • Fax:
Mailing address:
  • Phone: 843-766-7753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number6
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number159
License Number StateSC

VIII. Authorized Official

Name: MR. MARVIN E. ARD
Title or Position: PRESIDENT
Credential:
Phone: 843-766-7753