MEDICARE: DAVILA OPTOMETRIC GROUP PLLC

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

General Provider Information

NPI Number	:	1477343838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVILA OPTOMETRIC GROUP PLLC

Provider Business Mailing Address
First Line	:	7340 CIMARRON MARKET AVE
Second Line	:	BUILDING A, SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79912
Country	:	US
Telephone Number	:	224-623-7898
Fax Number	:

Provider Business Practice Location Address
First Line	:	7340 CIMARRON MARKET AVE
Second Line	:	BUILDING A, SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79912
Country	:	US
Telephone Number	:	224-623-7898
Fax Number	:	915-910-4003

Authorized Official
Title or Position	:	OPTOMETRIST/CO-OWNER
Name	:	KARINA DAVILA
Credential	:	OD
Telephone Number	:	224-623-7898

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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