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General NPI Number Information
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NPI Number | 1093994089
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Entity Type | Organization
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Legal Business Name | DR. CHRISTINE M DAVIS OD INC
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 2452 FENTON ST STE 104
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City | CHULA VISTA
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State | CA
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Zip | 91914-4551
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Country | US
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Telephone | 619-425-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 2452 FENTON ST STE 104
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City | CHULA VISTA
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State | CA
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Zip | 91914-4551
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Country | US
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Telephone | 619-425-5555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTINE M DAVIS
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Credential | OD
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Telephone | 619-425-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 12131TGL
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License Number State | CA
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