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General NPI Number Information
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NPI Number | 1902943194
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Entity Type | Individual
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Provider Name | JOHN ROBERT DAVIS OD
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4400 NORTH MAIN STREET
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 505-627-9872
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Fax |
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Provider Business Mailing Address
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Address Line | 104 FAIRWAY DR
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City | DEXTER
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State | NM
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Zip | 88230-9635
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Country | US
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Telephone | 505-734-2020
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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 | 228
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License Number State | NM
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