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General NPI Number Information
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NPI Number | 1306573936
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Entity Type | Organization
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Legal Business Name | DAVIDSON-MOORE EYECARE
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 1824 N MAIN ST
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City | HAZARD
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State | KY
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Zip | 41701-1020
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Country | US
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Telephone | 606-217-0920
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Fax | 606-217-0922
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Provider Business Mailing Address
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Address Line | 167 WOODLAND AVE
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City | HAZARD
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State | KY
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Zip | 41701-2060
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Country | US
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Telephone | 606-217-0920
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Fax | 606-217-0922
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. CHARLES JORDAN DAVIDSON
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Credential | OD
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Telephone | 606-217-0920
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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 |
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License Number State |
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