Healthcare Provider Details

I. General information

NPI: 1437320785
Provider Name (Legal Business Name): MICHAEL J DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ARTESIA ST STE 120
POMONA CA
91767-2920
US

IV. Provider business mailing address

288 N SANTA ANITA AVE STE 402
ARCADIA CA
91006-3183
US

V. Phone/Fax

Practice location:
  • Phone: 800-898-2020
  • Fax:
Mailing address:
  • Phone: 800-898-2020
  • Fax: 844-897-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA111866
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA111866
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036120010
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: