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General NPI Number Information
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NPI Number | 1306964382
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Entity Type | Organization
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Legal Business Name | DAVID S DAVIS OD PC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 4840 E BONANZA RD SUITE 6
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City | LAS VEGAS
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State | NV
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Zip | 89110-3453
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Country | US
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Telephone | 702-385-7331
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Fax | 702-385-5431
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Provider Business Mailing Address
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Address Line | 4840 E BONANZA RD SUITE 6
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City | LAS VEGAS
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State | NV
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Zip | 89110-3453
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Country | US
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Telephone | 702-385-7331
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Fax | 702-385-5431
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID SAMUEL DAVIS
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Credential | OD
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Telephone | 702-385-7331
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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 | NV245
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License Number State | NV
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