Provider Demographics
NPI:1013535798
Name:DAVIS, LAURA ANN (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
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 1:60 PRESIDENTIAL PLZ
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2292
Mailing Address - Country:US
Mailing Address - Phone:315-472-4594
Mailing Address - Fax:
Practice Address - Street 1:60 PRESIDENTIAL PLZ
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2292
Practice Address - Country:US
Practice Address - Phone:315-472-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003683152W00000X
NYTUV009334-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist