Healthcare Provider Details

I. General information

NPI: 1578496469
Provider Name (Legal Business Name): JILL ALEXIS YATES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 LONG GROVE DR
MT PLEASANT SC
29464-9462
US

IV. Provider business mailing address

1296 LONG GROVE DR
MT PLEASANT SC
29464-9462
US

V. Phone/Fax

Practice location:
  • Phone: 843-388-6200
  • Fax: 888-224-4732
Mailing address:
  • Phone: 843-388-6200
  • Fax: 888-224-4732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.2602
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: