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General NPI Number Information
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NPI Number | 1689670861
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Entity Type | Individual
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Provider Name | MICHAEL DAVIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | HWY 371 JUNCTION HWY 57 RT 9
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City | CROWNPOINT
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State | NM
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Zip | 87313
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Country | US
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Telephone | 505-786-5291
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Fax |
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Provider Business Mailing Address
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Address Line | 861 S 700 E
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2963
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Country | US
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Telephone | 505-409-8664
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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 | 2154
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License Number State | CO
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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 | 12403819-9934
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License Number State | UT
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