Provider Demographics
NPI:1427242981
Name:STEVEN A. DAVIS. O.D., P.S.
Entity type:Organization
Organization Name:STEVEN A. DAVIS. O.D., P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-338-7000
Mailing Address - Street 1:16030 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1741
Mailing Address - Country:US
Mailing Address - Phone:425-338-7000
Mailing Address - Fax:425-338-7814
Practice Address - Street 1:16030 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1741
Practice Address - Country:US
Practice Address - Phone:425-338-7000
Practice Address - Fax:425-338-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001979152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2027126Medicaid
WA0529240001Medicare NSC
WA8851288Medicare PIN