Healthcare Provider Details

I. General information

NPI: 1629090659
Provider Name (Legal Business Name): DENA DAVIDSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 LYNDELL TER SUITE 100
DAVIS CA
95616-6202
US

IV. Provider business mailing address

2035 LYNDELL TER SUITE 100
DAVIS CA
95616-6202
US

V. Phone/Fax

Practice location:
  • Phone: 530-757-6000
  • Fax: 530-231-5873
Mailing address:
  • Phone: 530-757-6000
  • Fax: 530-231-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT10473T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: