Provider Demographics
NPI:1013390921
Name:DAVIES, ALLISON ELIZABETH-EZELL (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:ELIZABETH-EZELL
Last Name:DAVIES
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 1:2472 S LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1462
Mailing Address - Country:US
Mailing Address - Phone:810-714-2020
Mailing Address - Fax:810-714-2021
Practice Address - Street 1:2472 S LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1462
Practice Address - Country:US
Practice Address - Phone:810-714-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004894152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist