1649902925 NPI number — TONYA RENEA DAVIS OPTICIAN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649902925 NPI number — TONYA RENEA DAVIS OPTICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
TONYA
Provider Middle Name:
RENEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OPTICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NANCE
Provider Other First Name:
TONYA
Provider Other Middle Name:
RENEA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OPTICIAN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649902925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
143 VALLEJO CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29206-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-608-4918
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WALMART VISION CENTER
Provider Second Line Business Practice Location Address:
7520 GARNERS FERRY RD
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-783-8348
Provider Business Practice Location Address Fax Number:
803-783-0715
Provider Enumeration Date:
06/27/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FC0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FC0800X , with the licence number: 462 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X , with the licence number: 734 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)