Provider Demographics
NPI:1114124831
Name:DAVIDSON OPTICAL DESIGN
Entity Type:Organization
Organization Name:DAVIDSON OPTICAL DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SLYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-243-2436
Mailing Address - Street 1:2 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-6781
Mailing Address - Country:US
Mailing Address - Phone:336-243-2436
Mailing Address - Fax:336-243-2635
Practice Address - Street 1:2 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6781
Practice Address - Country:US
Practice Address - Phone:336-243-2436
Practice Address - Fax:336-243-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131JTMedicaid
NC8977140Medicaid
NC210506BMedicare ID - Type Unspecified
NC2002248Medicare ID - Type Unspecified