Provider Demographics
NPI:1316718117
Name:DAVIS EYE PC
Entity type:Organization
Organization Name:DAVIS EYE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-635-5767
Mailing Address - Street 1:1901 16TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-2742
Mailing Address - Country:US
Mailing Address - Phone:561-501-1961
Mailing Address - Fax:
Practice Address - Street 1:1901 16TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-2742
Practice Address - Country:US
Practice Address - Phone:812-279-0148
Practice Address - Fax:812-279-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty