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General NPI Number Information
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NPI Number | 1902382146
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Entity Type | Organization
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Legal Business Name | DAVIS OPHTHALMOLOGY, PLLC
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 408 8TH ST STE 2
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-4167
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Country | US
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Telephone | 336-838-5121
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Fax | 336-667-5756
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Provider Business Mailing Address
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Address Line | 408 8TH ST STE 2
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-4167
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Country | US
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Telephone | 336-838-5121
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Fax | 336-667-5756
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Authorized Official
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Title or Position | REGISTERED AGENT/OWNER
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Name | DR. RONALD TYLER DAVIS
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Credential | DO
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Telephone | 336-838-5121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 201700503
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License Number State | NC
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