Provider Demographics
NPI:1154445963
Name:C M DAVIS OD PLLC
Entity Type:Organization
Organization Name:C M DAVIS OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:806-771-3926
Mailing Address - Street 1:PO BOX 68354
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-8354
Mailing Address - Country:US
Mailing Address - Phone:806-771-3926
Mailing Address - Fax:806-771-6986
Practice Address - Street 1:6002 SLIDE ROAD SUITE P-8
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414
Practice Address - Country:US
Practice Address - Phone:806-771-3926
Practice Address - Fax:806-771-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5803TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty