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General NPI Number Information
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NPI Number | 1114258159
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Entity Type | Organization
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Legal Business Name | DR. JEANMARIE DAVIS, OD, PA
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 1558 W 68TH ST
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City | HIALEAH
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State | FL
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Zip | 33014-3810
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Country | US
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Telephone | 954-336-1328
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Fax |
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Provider Business Mailing Address
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Address Line | 4842 SW 155TH TER
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City | MIRAMAR
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State | FL
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Zip | 33027-5642
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Country | US
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Telephone | 954-336-1328
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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. JEANMARIE DAVIS
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Credential | OD
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Telephone | 954-336-1328
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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 | OPC3579
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License Number State | FL
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