MEDICARE: JESSICA MICHELLE 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	18003724A	IN

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	:	1467713594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MICHELLE DAVIS OD

Provider Business Mailing Address
First Line	:	10660 S COUNTY ROAD 800 W
Second Line	:
City	:	DALEVILLE
State	:	IN
Zip	:	47334-9713
Country	:	US
Telephone Number	:	765-748-5219
Fax Number	:

Provider Business Practice Location Address
First Line	:	5535 S SCATTERFIELD RD
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46013-3140
Country	:	US
Telephone Number	:	765-642-7822
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/21/2013

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