Healthcare Provider Details

I. General information

NPI: 1235241381
Provider Name (Legal Business Name): JOHNNY RAY DUKES OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N MAIN ST
LANCASTER SC
29720-2188
US

IV. Provider business mailing address

929 N MAIN ST
LANCASTER SC
29720-2188
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-8433
  • Fax: 803-285-5071
Mailing address:
  • Phone: 803-285-8433
  • Fax: 803-285-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number767
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: