Provider Demographics
NPI:1427405877
Name:DAVIS, GREGORY (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 KITTANSETT CIR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8524
Mailing Address - Country:US
Mailing Address - Phone:281-395-1084
Mailing Address - Fax:
Practice Address - Street 1:12548-A WESTHEIMER RD.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-0000
Practice Address - Country:US
Practice Address - Phone:281-249-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3332-TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3332-TGOtherOPTOMETRY BOARD LICENSE NUMBER