Healthcare Provider Details

I. General information

NPI: 1891629523
Provider Name (Legal Business Name): GABRIELA LIMARY DAVILA RIVERA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 W LAYTON AVE
MILWAUKEE WI
53221-5310
US

IV. Provider business mailing address

10150 S WINDSOR DR
OAK CREEK WI
53154-5580
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number413835
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: