MEDICARE: DAVID S DAVIS OD PC

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	NV245	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306964382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID S DAVIS OD PC

Provider Business Mailing Address
First Line	:	4840 E BONANZA RD
Second Line	:	SUITE 6
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3453
Country	:	US
Telephone Number	:	702-385-7331
Fax Number	:	702-385-5431

Provider Business Practice Location Address
First Line	:	4840 E BONANZA RD
Second Line	:	SUITE 6
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3453
Country	:	US
Telephone Number	:	702-385-7331
Fax Number	:	702-385-5431

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID SAMUEL DAVIS
Credential	:	OD
Telephone Number	:	702-385-7331

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	01/08/2009

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