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General NPI Number Information
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NPI Number | 1457442857
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Entity Type | Individual
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Provider Name | JEANMARIE DAVIS OD
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1558 W 68TH ST
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City | HIALEAH
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State | FL
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Zip | 33014-3810
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Country | US
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Telephone | 305-556-0272
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Fax |
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Provider Business Mailing Address
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Address Line | 4842 SW 155TH TER
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City | MIRAMAR
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State | FL
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Zip | 33027-5642
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Country | US
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Telephone | 954-816-2424
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Fax | 954-322-1138
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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 | OPC3579
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License Number State | FL
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