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General NPI Number Information
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NPI Number | 1649276312
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Entity Type | Individual
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Provider Name | DAVID SAMUEL DAVIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 4840 E BONANZA RD UNIT 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 UNIT 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 |
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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 | NV245
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License Number State | NV
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