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General NPI Number Information
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NPI Number | 1538373139
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Entity Type | Organization
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Legal Business Name | RICHARD G. DAVIS, MD, PC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 1700 E JERICHO TPKE
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City | HUNTINGTON
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State | NY
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Zip | 11743-5614
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Country | US
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Telephone | 631-462-2020
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Fax | 631-462-2227
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Provider Business Mailing Address
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Address Line | 1700 E JERICHO TPKE
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City | HUNTINGTON
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State | NY
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Zip | 11743-5614
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Country | US
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Telephone | 631-462-2020
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Fax | 631-462-2227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD DAVIS
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Credential | MD
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Telephone | 631-462-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 170977
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License Number State | NY
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