MEDICARE: DR. LINDA KATHRYN DAVIDSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT 6196 TPA	CA
2	152W00000X	Optometrist	2414	TX

General Provider Information

NPI Number	:	1053338541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA KATHRYN DAVIDSON OD

Provider Business Mailing Address
First Line	:	2811 LORD BALTIMORE DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21244-2613
Country	:	US
Telephone Number	:	443-316-2101
Fax Number	:	410-265-6068

Provider Business Practice Location Address
First Line	:	17522 HAWTHORNE BLVD
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-3110
Country	:	US
Telephone Number	:	310-214-2970
Fax Number	:	310-214-5132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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