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NPI Code Detail

MEDICARE: DR. MARK COLLINS DAVIS OD

MEDICARE:  DR. MARK COLLINS DAVIS  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4901002801MI

General Provider Information

NPI Number : 1427108430
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK COLLINS DAVIS OD
Provider Business Mailing Address
First Line : 2820 E BELTLINE LN NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-9432
Country : US
Telephone Number : 616-363-5413
Fax Number : 616-363-4211
Provider Business Practice Location Address
First Line : 2820 E BELTLINE LN NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-9432
Country : US
Telephone Number : 616-363-5413
Fax Number : 616-363-4211
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2007
Last Update Date : 07/08/2007

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Directions to “ DR. MARK COLLINS DAVIS OD” Practice Location

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