MEDICARE: DR. LARRY LEE 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	203	NV

General Provider Information

NPI Number	:	1467533182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY LEE DAVIS O.D.

Provider Business Mailing Address
First Line	:	6707 W CHARLESTON BLVD
Second Line	:	SUITE 1B
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9240
Country	:	US
Telephone Number	:	702-878-8007
Fax Number	:	702-878-3140

Provider Business Practice Location Address
First Line	:	6707 W CHARLESTON BLVD
Second Line	:	SUITE 1B
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9240
Country	:	US
Telephone Number	:	702-878-8007
Fax Number	:	702-878-3140

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/14/2008

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