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General NPI Number Information
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NPI Number | 1487707881
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Entity Type | Organization
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Legal Business Name | JACKSON ARD VISION CENTER
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 975 SAVANNAH HWY
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City | CHARLESTON
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State | SC
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Zip | 29407-7859
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Country | US
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Telephone | 843-166-7753
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31919
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City | CHARLESTON
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State | SC
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Zip | 29417-1919
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Country | US
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Telephone | 843-766-7753
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARVIN E. ARD
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Credential |
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Telephone | 843-766-7753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | 6
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 159
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License Number State | SC
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