Provider Demographics
NPI:1063482453
Name:DAVIS, WILLIAM GIL (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GIL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14994 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2616
Mailing Address - Country:US
Mailing Address - Phone:662-773-3494
Mailing Address - Fax:
Practice Address - Street 1:107 DECATUR ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-2309
Practice Address - Country:US
Practice Address - Phone:601-683-3241
Practice Address - Fax:601-683-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087007Medicaid
MST78338Medicare UPIN
MS00087007Medicaid