MEDICARE: MRS. KIMBERLY ANN DAVIS OPTOMETRY TECH

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	156FX1202X	Optometric Technician

General Provider Information

NPI Number	:	1497157176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN DAVIS OPTOMETRY TECH

Provider Business Mailing Address
First Line	:	492 VICTORS CT
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-9320
Country	:	US
Telephone Number	:	804-894-7315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 HARMON AVE
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31314-5641
Country	:	US
Telephone Number	:	912-435-5696
Fax Number	:

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

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/24/2014

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