MEDICARE: DAVIDSON OPTOMETRY PC

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
1	152W00000X	Optometrist	2000160780	MO

General Provider Information

NPI Number	:	1427393925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIDSON OPTOMETRY PC

Provider Business Mailing Address
First Line	:	1000 DES PERES RD STE 105
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2062
Country	:	US
Telephone Number	:	314-628-9100
Fax Number	:	844-235-0998

Provider Business Practice Location Address
First Line	:	1000 DES PERES RD STE 105
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2062
Country	:	US
Telephone Number	:	314-628-9100
Fax Number	:	844-235-0998

Authorized Official
Title or Position	:	OWNER, OPTOMETRIST
Name	:	DR. CHERYL L DAVIDSON
Credential	:	O.D.
Telephone Number	:	314-628-9100

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	09/27/2023

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