MEDICARE: DR. DAVID SAMUEL DAVIS O.D.

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	NV245	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410049343	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649276312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SAMUEL DAVIS O.D.

Provider Business Mailing Address
First Line	:	4840 E BONANZA RD
Second Line	:	UNIT 6
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3453
Country	:	US
Telephone Number	:	702-385-7331
Fax Number	:	702-385-5431

Provider Business Practice Location Address
First Line	:	4840 E BONANZA RD
Second Line	:	UNIT 6
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3453
Country	:	US
Telephone Number	:	702-385-7331
Fax Number	:	702-385-5431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	01/13/2009

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Directions to “ DR. DAVID SAMUEL DAVIS O.D.” Practice Location

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