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General NPI Number Information
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NPI Number | 1366492357
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Entity Type | Individual
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Provider Name | JAMES E DAVIS JR. O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3411 N WOODFORD ST
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City | DECATUR
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State | IL
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Zip | 62526-2861
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Country | US
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Telephone | 217-877-0312
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Fax | 217-877-0397
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Provider Business Mailing Address
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Address Line | 3411 N WOODFORD ST
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City | DECATUR
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State | IL
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Zip | 62526-2861
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Country | US
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Telephone | 217-877-0312
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Fax | 217-877-0397
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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 | 046007432
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002009B
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License Number State | IN
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