Healthcare Provider Details

I. General information

NPI: 1366632770
Provider Name (Legal Business Name): JAMIE MARIE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST DEPT. OF OPTHALMOLOGY
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

3425 N CARLISLE ST 2ND FLOOR HUDSON BUILDING
PHILADELPHIA PA
19140-5108
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3185
  • Fax: 215-707-1684
Mailing address:
  • Phone: 215-707-8561
  • Fax: 215-707-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: