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General NPI Number Information
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NPI Number | 1962954594
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Entity Type | Organization
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Legal Business Name | CLAYTON DAVIS, OD OF SOUTH CAROLINA, LLC
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 200 N BELTLINE DR
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City | FLORENCE
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State | SC
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Zip | 29501-7403
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Country | US
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Telephone | 843-662-2769
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 MOSER DR # 711
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-1575
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Country | US
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Telephone | 806-778-9074
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Fax |
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Authorized Official
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Title or Position | OPTOMETRY
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Name | DR. CLAYTON DAVIS
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Credential | O.D.
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Telephone | 806-778-9074
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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 | 1870
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License Number State | SC
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