Provider Demographics
NPI:1962528158
Name:BARRY J DAVIS & DON A REEVES PTR
Entity type:Organization
Organization Name:BARRY J DAVIS & DON A REEVES PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:409-722-6141
Mailing Address - Street 1:8700 CENTRAL MALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8058
Mailing Address - Country:US
Mailing Address - Phone:409-722-6141
Mailing Address - Fax:409-724-2405
Practice Address - Street 1:8700 CENTRAL MALL DRIVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8058
Practice Address - Country:US
Practice Address - Phone:409-722-6141
Practice Address - Fax:409-724-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0539250002Medicare NSC
TX00E57WMedicare PIN