Provider Demographics
NPI:1346739075
Name:WARD, COURTNEY TERESSA (OD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:TERESSA
Last Name:WARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 GEORGIANNA DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-5552
Mailing Address - Country:US
Mailing Address - Phone:803-983-2269
Mailing Address - Fax:
Practice Address - Street 1:2377 DAVE LYLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-7939
Practice Address - Country:US
Practice Address - Phone:803-366-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2055152W00000X
NC2542152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist