Healthcare Provider Details

I. General information

NPI: 1912928516
Provider Name (Legal Business Name): JASON FRANKLIN BALDWIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 GATEWAY DR
LADSON SC
29456-3552
US

IV. Provider business mailing address

4850 ENCORE BLVD
MT PLEASANT MI
48858-6013
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-3676
  • Fax: 843-797-3677
Mailing address:
  • Phone: 989-772-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004373
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1510
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003718
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: