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General NPI Number Information
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NPI Number | 1306988399
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Entity Type | Individual
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Provider Name | DINA RUTH DAVIS OD
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 4201 N SHILOH DR OPTICAL DEPT.
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5180
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Country | US
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Telephone | 479-695-2152
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 E ZION RD STE 13
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5070
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Country | US
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Telephone | 479-444-6148
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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 | 2534
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License Number State | AR
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