BOULEVARD PLAZA INC (NPI# 1184719387) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184719387 |
| Entity Type | Organization |
| Organization Name | BOULEVARD PLAZA INC |
| Practice Address |
101 Old Trolley Rd Summerville SC 29485-4908 |
| Practice Telephone | 8438719750 |
| Practice Fax Number | 8438736197 |
| Mailing Telephone | 8438719750 |
| Mailing Fax Number | 8438736197 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | MR. KENNETH RICHARD DAVENPORT II (PRESIDENT) |
| Authorized Official Telephone | 8438719750 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 156FX1800X |
Technician/Technologist Specialization: Optician |
686 | SC | Eye and Vision Services Providers |
| Y | 152W00000X | Optometrist | 589 | SC | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | DA9858 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | BOULEVARD PLAZA INC. | 4076 Ridge Rd, Chincoteague, Virginia 23336 |
| Street Address |
101 OLD TROLLEY RD |
| City | SUMMERVILLE |
| State | SC |
| Zip Code | 29485-4908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881197648 | Jackson Davenport Vision Services, LLC | Optometrist | 101 Old Trolley Rd, Summerville, SC 29485-4908 | 2018-03-17 |
| 1821110578 | Ferine N. Johannes | Optometrist | 101 Old Trolley Rd, Summerville, SC 29485-4908 | 2007-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487267365 | Cp Dentistry, LLC | Dentist | 9919 Dorchester Road, Summerville, SC 29485 | 2020-08-28 |
| 1922622604 | Rachel Elaine Digiacomo | Physical Therapist | 10160 Dorchester Road, Summerville, SC 29485 | 2020-05-29 |
| 1396220034 | Amanda W Peebles | Nurse Practitioner | 4278 Ladson Rd., Summerville, SC 29485 | 2018-09-28 |
| 1396230728 | Gerald Darnell Woods | Counselor | 10825 Dorchester Rd. #3077, Summerville, SC 29485 | 2018-06-27 |
| 1063901072 | Elite Barber Spa, LLC | Specialist | 850 E Bacons Bridge Road, Suite 303, Summerville, SC 29485 | 2018-05-04 |
| 1598253528 | Daniel Joseph Neitzke | Student in an Organized Health Care Education/Training Program | 9228 Medical Plaza Drive, Charleston, SC 29485 | 2018-04-25 |
| 1700315447 | Donna Marie White | Counselor | 9214 Ayscough Road, Summerville, SC 29485 | 2017-06-07 |
| 1043763212 | Brockman Davis Smith | Dentist | 1710 B Trolley Road, Summerville, SC 29485 | 2016-07-25 |
| 1336508530 | Meca Home Health, LLC | Home Health | 415 Savannah River Rd, Summerville, SC 29485 | 2016-02-16 |
| 1609241033 | Dental Professionals of South Carolina, PC | Dentist | 9510 Dorchester Rd, Suite 400, North Charleston, SC 29485 | 2015-12-10 |
| Find all providers in zip 29485 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720696792 | National Vision Inc | Optometrist | 1317 N Main St Ste A3, Summerville, SC 29483-7342 | 2020-07-16 |
| 1750928164 | Tidewater Eyecare, LLC | Optometrist | 301 Front St., Summerville, SC 29486 | 2019-12-04 |
| 1265958524 | James Harrison Kyte | Optometrist | 717 Old Trolley Rd Ste 4, Summerville, SC 29485-5287 | 2017-08-18 |
| 1700319282 | Lowcountry Eye Care of Cane Bay, LLC | Optometrist | 1718 State Rd # 176, Suite 3 (8d), Summerville, SC 29486-2801 | 2017-04-11 |
| 1457758088 | James F. Deavers, Od, Pa | Optometrist | 11317 North Main Street, Summerville, SC 29483 | 2014-11-25 |
| 1144646753 | Special Care Vision of Sc, LLC | Optometrist | 717 Trolley Road, Summerville, SC 29485 | 2014-03-07 |
| 1841584364 | Monarch Eye Care LLC | Optometrist | 221 Forsythia Ave, Summerville, SC 29483-5368 | 2011-06-01 |
| 1275867061 | Catherine E. Kister, O.d. LLC | Optometrist | 1112 N Main St Ste E, Summerville, SC 29483-7315 | 2009-09-25 |
| 1700073749 | Ocean Eye, PC | Optometrist | 717 Old Trolley Rd Ste 3, Summerville, SC 29485-5287 | 2007-10-03 |
| 1013116037 | William Justin Dungan | Optometrist | 717 Trolley Rd Ste 3, Summerville, SC 29485-5287 | 2007-07-11 |
| Find all providers in SUMMERVILLE | ||||
| City | SUMMERVILLE |
| Zip Code | 29485 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.