Provider Demographics
NPI:1306573936
Name:DAVIDSON-MOORE EYECARE
Entity type:Organization
Organization Name:DAVIDSON-MOORE EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-217-0920
Mailing Address - Street 1:167 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2060
Mailing Address - Country:US
Mailing Address - Phone:606-217-0920
Mailing Address - Fax:606-217-0922
Practice Address - Street 1:1824 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1020
Practice Address - Country:US
Practice Address - Phone:606-217-0920
Practice Address - Fax:606-217-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty