Provider Demographics
NPI:1962954594
Name:CLAYTON DAVIS, OD OF SOUTH CAROLINA, LLC
Entity type:Organization
Organization Name:CLAYTON DAVIS, OD OF SOUTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:806-778-9074
Mailing Address - Street 1:1206 MOSER DR # 711
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1575
Mailing Address - Country:US
Mailing Address - Phone:806-778-9074
Mailing Address - Fax:
Practice Address - Street 1:200 N BELTLINE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7403
Practice Address - Country:US
Practice Address - Phone:843-662-2769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty