1700855111 NPI number — DR. HARRY DAVIS O.D.

Table of content: DR. HARRY DAVIS O.D. (NPI 1700855111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700855111 NPI number — DR. HARRY DAVIS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
HARRY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700855111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
888 E COURT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43078-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-653-5005
Provider Business Mailing Address Fax Number:
937-653-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
888 E COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43078-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-653-5005
Provider Business Practice Location Address Fax Number:
937-653-5363
Provider Enumeration Date:
03/16/2006

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: 152W00000X , with the licence number:  5021-T1898 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4396320001 . This is a "ADMINSTAR FEDERAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2278253 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: OH1898 . This is a "EYEMED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 410047132 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 23034 . This is a "SPECTERA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311811075 . This is a "WORKMAN COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7986032 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 33287 . This is a "COORDINATED VISION CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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