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General NPI Number Information
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NPI Number | 1104981042
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Entity Type | Individual
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Provider Name | YELENA DAVYDOVA OD
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Gender | Female
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 539 PARKWAY PLZ
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City | EL CAJON
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State | CA
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Zip | 92020-2532
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Country | US
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Telephone | 619-441-0138
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Fax |
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Provider Business Mailing Address
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Address Line | 8692 LAKE ASHMERE DR
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City | SAN DIEGO
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State | CA
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Zip | 92119-3203
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Country | US
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Telephone | 619-957-1616
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Fax |
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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 | 12562T
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License Number State | CA
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