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NPI Code Detail

MEDICARE: DR. JEANMARIE DAVIS, OD, PA

MEDICARE: DR. JEANMARIE DAVIS, OD, PA
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
1152W00000XOptometristOPC3579FL

General Provider Information

NPI Number : 1114258159
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. JEANMARIE DAVIS, OD, PA
Provider Business Mailing Address
First Line : 4842 SW 155TH TER
Second Line :
City : MIRAMAR
State : FL
Zip : 33027-5642
Country : US
Telephone Number : 954-336-1328
Fax Number :
Provider Business Practice Location Address
First Line : 1558 W 68TH ST
Second Line :
City : HIALEAH
State : FL
Zip : 33014-3810
Country : US
Telephone Number : 954-336-1328
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. JEANMARIE DAVIS
Credential : OD
Telephone Number : 954-336-1328
Provider Enumeration Date : 01/14/2010
Last Update Date : 01/14/2010

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