Provider Demographics
NPI:1184672776
Name:DAVIS, NICHOLAS K (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:900 HOLT RD
Practice Address - Street 2:EMPIRE VISION CENTERS WEGMANS PLAZA
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9102
Practice Address - Country:US
Practice Address - Phone:585-872-2200
Practice Address - Fax:585-872-2314
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT0028701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB1167Medicare PIN
NYRB1168Medicare PIN
NYRB1166Medicare PIN
U79426Medicare UPIN
NYBB9783Medicare ID - Type Unspecified
NYRB1169Medicare PIN