Provider Demographics
NPI:1235146903
Name:RICHARDS, JEFFREY KENDAL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:KENDAL
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 CHARLIE HALL BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6066
Mailing Address - Country:US
Mailing Address - Phone:843-769-5777
Mailing Address - Fax:843-769-5571
Practice Address - Street 1:2060 CHARLIE HALL BLVD
Practice Address - Street 2:STE 201
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6066
Practice Address - Country:US
Practice Address - Phone:843-769-5777
Practice Address - Fax:843-769-5571
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8566207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0191Medicaid
SC406183919OtherRAILROAD MEDICARE
SC5910Medicare PIN
SC5909Medicare PIN
SC5912Medicare PIN
SC406183919OtherRAILROAD MEDICARE
SC5911Medicare PIN