Provider Demographics
NPI:1992936892
Name:DAVIS, TANGEE MELISSA (OD)
Entity type:Individual
Prefix:DR
First Name:TANGEE
Middle Name:MELISSA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 SUN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4371
Mailing Address - Country:US
Mailing Address - Phone:205-253-1277
Mailing Address - Fax:
Practice Address - Street 1:1111 A FORT CAMPBELL BLVD.
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042
Practice Address - Country:US
Practice Address - Phone:931-645-0346
Practice Address - Fax:931-645-0348
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2881152W00000X
ALS-C15-TA-826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1534403Medicaid