MEDICARE: JEANETTA L. DAVIS C.O.A.

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	156FX1101X	Ophthalmic Assistant

General Provider Information

NPI Number	:	1083623334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTA L. DAVIS C.O.A.

Provider Business Mailing Address
First Line	:	2480 S DOWNING ST
Second Line	:	STE G20
City	:	DENVER
State	:	CO
Zip	:	80210-5890
Country	:	US
Telephone Number	:	303-777-7303
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 S DOWNING ST
Second Line	:	STE G20
City	:	DENVER
State	:	CO
Zip	:	80210-5890
Country	:	US
Telephone Number	:	303-777-7303
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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