MEDICARE: DR. MARVIN S MCMEEKIN O.D.

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	152W00000X	Optometrist	S-819-TA-183	AL
2	152W00000X	Optometrist	1046	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598768913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN S MCMEEKIN O.D.

Provider Business Mailing Address
First Line	:	16 FERNWALK PL
Second Line	:
City	:	TAYLORS
State	:	SC
Zip	:	29687-4603
Country	:	US
Telephone Number	:	864-268-4204
Fax Number	:	864-268-4244

Provider Business Practice Location Address
First Line	:	2411 HUDSON RD
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-2923
Country	:	US
Telephone Number	:	864-268-4204
Fax Number	:	864-268-4244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	11/28/2012

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