Healthcare Provider Details

I. General information

NPI: 1700855111
Provider Name (Legal Business Name): HARRY DAVIS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 E COURT ST
URBANA OH
43078-1835
US

IV. Provider business mailing address

888 E COURT ST
URBANA OH
43078-1835
US

V. Phone/Fax

Practice location:
  • Phone: 937-653-5005
  • Fax: 937-653-5363
Mailing address:
  • Phone: 937-653-5005
  • Fax: 937-653-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5021-T1898
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: