Provider Demographics
NPI:1184739740
Name:ODONNELL, COLVIN HUNTER (OD)
Entity type:Individual
Prefix:DR
First Name:COLVIN
Middle Name:HUNTER
Last Name:ODONNELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 LAGOON PARK CIR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9013
Mailing Address - Country:US
Mailing Address - Phone:843-352-7401
Mailing Address - Fax:
Practice Address - Street 1:2150 NORTHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4021
Practice Address - Country:US
Practice Address - Phone:843-818-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist