Provider Demographics
NPI:1114554045
Name:DAVIS FARHAT, SYDNI KAYE (OD)
Entity Type:Individual
Prefix:DR
First Name:SYDNI
Middle Name:KAYE
Last Name:DAVIS FARHAT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SYDNI
Other - Middle Name:KAYE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 BONHOMME RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-1761
Mailing Address - Country:US
Mailing Address - Phone:314-941-9818
Mailing Address - Fax:
Practice Address - Street 1:5865 W UTOPIA RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5251
Practice Address - Country:US
Practice Address - Phone:623-537-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020014779152W00000X
390200000X
AZ002432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program