Provider Demographics
NPI:1275557670
Name:DAVIS, TOD R (OD)
Entity type:Individual
Prefix:DR
First Name:TOD
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10687 GASKINS WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109
Mailing Address - Country:US
Mailing Address - Phone:703-753-9777
Mailing Address - Fax:703-753-9077
Practice Address - Street 1:10687 GASKINS WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109
Practice Address - Country:US
Practice Address - Phone:703-753-9777
Practice Address - Fax:703-753-9077
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601002358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009230831Medicaid
VA317179OtherANTHEM PROVIDER ID
VAOTH000Medicare UPIN