Provider Demographics
NPI:1093141483
Name:DAVIS, JEFFREY S (BCO, BADO)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BCO, BADO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 CORPORATE DR STE 213
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-2407
Mailing Address - Country:US
Mailing Address - Phone:608-630-9200
Mailing Address - Fax:844-518-5724
Practice Address - Street 1:258 CORPORATE DR STE 213
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-2407
Practice Address - Country:US
Practice Address - Phone:608-630-9200
Practice Address - Fax:844-518-5724
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist