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NPI Code Detail

MEDICARE: DR. JACQUELINE GOINGS DAVIS O.D.

MEDICARE: DR. JACQUELINE GOINGS 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
1152W00000XOptometrist3532/403OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902885734
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE GOINGS DAVIS O.D.
Provider Business Mailing Address
First Line : 1160 W BROAD ST
Second Line : LOWER LIGHTS CHRISTIAN HEALTH CENTER
City : COLUMBUS
State : OH
Zip : 43222-1317
Country : US
Telephone Number : 614-274-1455
Fax Number : 614-274-2040
Provider Business Practice Location Address
First Line : 1160 W BROAD ST
Second Line : LOWER LIGHTS CHRISTIAN HEALTH CENTER
City : COLUMBUS
State : OH
Zip : 43222-1317
Country : US
Telephone Number : 614-274-1455
Fax Number : 614-274-2040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 08/08/2014

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