Healthcare Provider Details

I. General information

NPI: 1003220138
Provider Name (Legal Business Name): JUSTINE J O'DELL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 HAYWOOD ROAD
GREENVILLE SC
29607
US

IV. Provider business mailing address

532 HAYWOOD ROAD
GREENVILLE SC
29607
US

V. Phone/Fax

Practice location:
  • Phone: 864-288-7445
  • Fax: 864-288-8288
Mailing address:
  • Phone: 864-288-7445
  • Fax: 864-288-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1823
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1823
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1823
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1823
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1823
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: