MEDICARE: DR. DONALD JOE KOETS OD

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	SC497	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	014055	OTHER	SC	AOA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689667016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD JOE KOETS OD

Provider Business Mailing Address
First Line	:	206 E 2ND NORTH ST
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6858
Country	:	US
Telephone Number	:	843-851-1037
Fax Number	:	843-851-1392

Provider Business Practice Location Address
First Line	:	206 E 2ND NORTH ST
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6858
Country	:	US
Telephone Number	:	843-851-1037
Fax Number	:	843-851-1392

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/07/2023

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