Healthcare Provider Details

I. General information

NPI: 1942782321
Provider Name (Legal Business Name): NAYAB DAVIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NAYAB GILL OD

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 PIERCE ST
KINGSTON PA
18704-5532
US

IV. Provider business mailing address

76 N GATES AVE
KINGSTON PA
18704-5506
US

V. Phone/Fax

Practice location:
  • Phone: 570-714-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3281
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV009660
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003476
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003203
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-OPT-LIC-4593
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTPOP116
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3855-35
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number21334-875
License Number StateWI
# 9
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number61128304
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: