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General NPI Number Information
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NPI Number | 1134290257
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Entity Type | Individual
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Provider Name | MICHAEL I. DAVIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6300 GEORGETOWN BLVD SUITE121
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City | ELDERSBURG
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State | MD
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Zip | 21784-6481
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Country | US
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Telephone | 410-795-8670
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Fax | 410-795-2680
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Provider Business Mailing Address
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Address Line | 6838 LITTLEWOOD CT
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City | SYKESVILLE
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State | MD
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Zip | 21784-5943
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Country | US
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Telephone | 410-549-3926
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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 | TA0836
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License Number State | MD
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