MEDICARE: DR. JEANMARIE DAVIS 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	OPC3579	FL

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	:	1457442857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANMARIE DAVIS OD

Provider Business Mailing Address
First Line	:	4842 SW 155TH TER
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-5642
Country	:	US
Telephone Number	:	954-816-2424
Fax Number	:	954-322-1138

Provider Business Practice Location Address
First Line	:	1558 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3810
Country	:	US
Telephone Number	:	305-556-0272
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/09/2007

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