Provider Demographics
NPI:1699760603
Name:DAVIS, MARK KEITH (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:KEITH
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 1:6603 FM 2920 RD
Mailing Address - Street 2:SPRING KLEIN VISION CENTER
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2636
Mailing Address - Country:US
Mailing Address - Phone:281-370-4444
Mailing Address - Fax:281-320-2012
Practice Address - Street 1:1742 N LOOP 1604 E
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1593
Practice Address - Country:US
Practice Address - Phone:210-403-9050
Practice Address - Fax:210-403-9939
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-11-06
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TX3460TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000072FCOtherBCBS
TX161053701Medicaid
TX80575QOtherBCBS
TX200122447OtherAETNA
TX100404603Medicaid
TX136734195824OtherHUMANA
TX200122447OtherUNITED HEALTH CARE
TX200122447OtherAETNA
TX161053701Medicaid