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General NPI Number Information
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NPI Number | 1699760603
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Entity Type | Individual
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Provider Name | MARK KEITH DAVIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 1742 N LOOP 1604 E SUITE 118
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1593
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Country | US
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Telephone | 210-403-9050
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Fax | 210-403-9939
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Provider Business Mailing Address
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Address Line | 6603 FM 2920 RD SPRING KLEIN VISION CENTER
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City | SPRING
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State | TX
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Zip | 77379-2636
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Country | US
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Telephone | 281-370-4444
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Fax | 281-320-2012
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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 | 3460TG
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License Number State | TX
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