Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Physician Practices LLC

Organization Optometrist · NPI 1659921740

Providence Physician Practices LLC is an Optometrist in Kershaw, South Carolina. Registered with an NPI since 2019.

In the registry since
2019
Specialties on file
9
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

216 E Marion St
Kershaw, SC 29067-1442
Phone: (803) 475-3350
Fax: (803) 475-5360
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Optometrist Taxonomy 152W00000X
Family Medicine Physician Taxonomy 207Q00000X
Cardiovascular Disease Physician Taxonomy 207RC0000X
Endocrinology, Diabetes & Metabolism Physician Taxonomy 207RE0101X
Obstetrics & Gynecology Physician Taxonomy 207V00000X
Ophthalmology Physician Taxonomy 207W00000X
Pediatrics Physician Taxonomy 208000000X
Gerontology Nurse Practitioner Taxonomy 363LG0600X

Record details

NPI number1659921740
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kathy Teague — Corporate Secretary · (615) 920-7646
NPI enumeratedSeptember 19, 2019
Last updated in NPPESDecember 9, 2019
Certification dateDecember 9, 2019
Mailing address330 Seven Springs Way, Brentwood, TN 37027-5098

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