MEDICARE: MEGAN MARIE SEXTON 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	1769	SC

General Provider Information

NPI Number	:	1740612506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MARIE SEXTON O.D.

Provider Business Mailing Address
First Line	:	2750 JOBEE DR APT 8
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-6529
Country	:	US
Telephone Number	:	843-708-8413
Fax Number	:

Provider Business Practice Location Address
First Line	:	1470 TOBIAS GADSON BLVD STE 115
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4835
Country	:	US
Telephone Number	:	843-556-2020
Fax Number	:

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

Provider Enumeration Date	:	08/05/2013
Last Update Date	:	10/03/2013

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