Healthcare Provider Details

I. General information

NPI: 1093177917
Provider Name (Legal Business Name): MEGAN VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 LEADENWAH DR
WADMALAW ISLAND SC
29487-6973
US

IV. Provider business mailing address

1837 LEADENWAH DR
WADMALAW ISLAND SC
29487-6973
US

V. Phone/Fax

Practice location:
  • Phone: 843-559-6748
  • Fax:
Mailing address:
  • Phone: 843-559-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN ROSS POWELL
Title or Position: SOLE MEMBER
Credential: OD
Phone: 843-559-6748