Healthcare Provider Details

I. General information

NPI: 1841478369
Provider Name (Legal Business Name): DAVIS EYEWEAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32313 VINE ST
WILLOWICK OH
44095-3341
US

IV. Provider business mailing address

32313 VINE ST
WILLOWICK OH
44095-3341
US

V. Phone/Fax

Practice location:
  • Phone: 440-943-6858
  • Fax: 440-943-5178
Mailing address:
  • Phone: 440-943-6858
  • Fax: 440-943-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: TERRY LEE DAVIS
Title or Position: TREASURER
Credential:
Phone: 440-666-7666