Healthcare Provider Details

I. General information

NPI: 1558564401
Provider Name (Legal Business Name): CONNIE ALLEEN DAVIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 BEL AIR MALL
MOBILE AL
36606-3207
US

IV. Provider business mailing address

3291 BEL AIR MALL
MOBILE AL
36606-3207
US

V. Phone/Fax

Practice location:
  • Phone: 251-476-2015
  • Fax: 251-478-5360
Mailing address:
  • Phone: 251-476-2015
  • Fax: 251-478-5360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-725-TA-306
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: