MEDICARE: M.S. MCMEEKIN, O.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	1046	SC

General Provider Information

NPI Number	:	1508164203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.S. MCMEEKIN, O.D., LLC

Provider Business Mailing Address
First Line	:	16 FERNWALK PL
Second Line	:
City	:	TAYLORS
State	:	SC
Zip	:	29687-4603
Country	:	US
Telephone Number	:	864-881-1393
Fax Number	:

Provider Business Practice Location Address
First Line	:	2411 HUDSON RD
Second Line	:	EASTSIDE EYECARE
City	:	GREER
State	:	SC
Zip	:	29650-2923
Country	:	US
Telephone Number	:	864-881-1393
Fax Number	:	864-752-1046

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. MARVIN S MCMEEKIN
Credential	:	O.D.
Telephone Number	:	864-881-1393

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/04/2011

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