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General NPI Number Information
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NPI Number | 1013042068
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Entity Type | Individual
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Provider Name | DEVIN J DAVIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 139 W 3RD ST
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City | CHADRON
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State | NE
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Zip | 69337-2313
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Country | US
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Telephone | 308-432-2200
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Fax | 308-432-3616
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Provider Business Mailing Address
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Address Line | 139 W 3RD ST
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City | CHADRON
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State | NE
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Zip | 69337-2313
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Country | US
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Telephone | 308-432-2200
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Fax | 308-432-3616
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 200T
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1352
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License Number State | NE
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