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General NPI Number Information
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NPI Number | 1235327396
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Entity Type | Organization
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Legal Business Name | JACQUELINE G. DAVIS OPTOMETRIST INC
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Dates
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Enumeration Date | 10/13/2007
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 2696 CROSSROADS PLAZA DR
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City | COLUMBUS
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State | OH
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Zip | 43219-3442
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Country | US
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Telephone | 614-471-9005
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Fax | 614-471-2791
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Provider Business Mailing Address
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Address Line | 2696 CROSSROADS PLAZA DR
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City | COLUMBUS
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State | OH
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Zip | 43219-3442
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Country | US
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Telephone | 614-471-9005
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Fax | 614-471-2791
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUELINE G. DAVIS
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Credential | O.D.
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Telephone | 614-471-9005
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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 | 3532
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License Number State | OH
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