Healthcare Provider Details

I. General information

NPI: 1588854814
Provider Name (Legal Business Name): ALEQUE STEGALL JAMES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 N CONGRESS ST
YORK SC
29745-1529
US

IV. Provider business mailing address

PO BOX 745
YORK SC
29745-0745
US

V. Phone/Fax

Practice location:
  • Phone: 803-628-5477
  • Fax: 803-628-5474
Mailing address:
  • Phone: 803-628-5477
  • Fax: 803-628-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1477
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: