MEDICARE: DR. FREDDIE J DAVIS O.D.

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	27OA00612800	NJ

General Provider Information

NPI Number	:	1427055748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDDIE J DAVIS O.D.

Provider Business Mailing Address
First Line	:	1808 LONG BEACH BLVD
Second Line	:
City	:	SHIP BOTTOM
State	:	NJ
Zip	:	08008-4443
Country	:	US
Telephone Number	:	609-494-6868
Fax Number	:	609-494-0990

Provider Business Practice Location Address
First Line	:	1808 LONG BEACH BLVD
Second Line	:
City	:	SHIP BOTTOM
State	:	NJ
Zip	:	08008-4443
Country	:	US
Telephone Number	:	609-494-6868
Fax Number	:	609-494-0990

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	01/17/2012

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