Dr. Kacie A Breault, OD
Optometrist in Indian Land, SC. Individual provider (NPI-1).
NPI number1720100415
StatusActive
Last updated in NPPESJul 7, 2025
Details
- NPI
- 1720100415
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kacie A Breault
- Credential
- OD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 4, 2007
- Certification date
- Jul 7, 2025
- Last updated
- Jul 7, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - OPTOMETRY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 2382 | SC | Yes |
| 152W00000X | Optometrist | OPC 4002 | FL |
Practice location
2077 Parkway Dr Ste 102Indian Land, SC 29707-8088
Phone 839-293-0292 · Fax 839-293-0293
Mailing address
2077 Parkway Dr Ste 102Indian Land, SC 29707-8088
Fax 839-293-0293
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 17 Optometrist providers in Indian Land · All 308 providers in Indian Land
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