Healthcare Provider Details

I. General information

NPI: 1376739334
Provider Name (Legal Business Name): JENNIFER NICOLE MEADOWS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2007
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 8TH DIV RD
FT JACKSON SC
29207
US

IV. Provider business mailing address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-5406
  • Fax:
Mailing address:
  • Phone: 38-751-5406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2622
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1745
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: