MEDICARE: BARRY J 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	01812TG	TX

General Provider Information

NPI Number	:	1912060989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY J DAVIS O.D.

Provider Business Mailing Address
First Line	:	3429 N TWIN CITY HWY
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-2102
Country	:	US
Telephone Number	:	409-963-0173
Fax Number	:	409-962-8405

Provider Business Practice Location Address
First Line	:	3429 N TWIN CITY HWY
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-2102
Country	:	US
Telephone Number	:	409-963-0173
Fax Number	:	409-962-8405

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	02/17/2016

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