Provider Demographics
NPI:1306988399
Name:DAVIS, DINA RUTH (OD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:RUTH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 E ZION RD
Mailing Address - Street 2:STE 13
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5070
Mailing Address - Country:US
Mailing Address - Phone:479-444-6148
Mailing Address - Fax:
Practice Address - Street 1:4201 N SHILOH DR
Practice Address - Street 2:OPTICAL DEPT.
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5180
Practice Address - Country:US
Practice Address - Phone:479-695-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist