Provider Demographics
NPI:1134290257
Name:DAVIS, MICHAEL I (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6838 LITTLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5943
Mailing Address - Country:US
Mailing Address - Phone:410-549-3926
Mailing Address - Fax:
Practice Address - Street 1:6300 GEORGETOWN BLVD
Practice Address - Street 2:SUITE121
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6481
Practice Address - Country:US
Practice Address - Phone:410-795-8670
Practice Address - Fax:410-795-2680
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist