Provider Demographics
NPI:1285624320
Name:DAVIS, LOUISE COOLEY (MD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:COOLEY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:COOLEY
Other - Last Name:KALDIS-DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9001 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1841
Mailing Address - Country:US
Mailing Address - Phone:310-247-0348
Mailing Address - Fax:310-247-1054
Practice Address - Street 1:9001 WILSHIRE BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1841
Practice Address - Country:US
Practice Address - Phone:310-247-0348
Practice Address - Fax:310-247-1054
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8606207W00000X
CAC42406207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C42406Medicaid
CA00C424060Medicaid
CA695651OtherPIN
TXE8606OtherTEXAS STATE LICENCE
CAC42406Medicare ID - Type Unspecified
CAB23824Medicare UPIN