Provider Demographics
NPI:1235305095
Name:HARRY DAVIS, O.D. INC
Entity Type:Organization
Organization Name:HARRY DAVIS, O.D. INC
Other - Org Name:PROFESSIONAL VISION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-592-5005
Mailing Address - Street 1:1711 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1509
Mailing Address - Country:US
Mailing Address - Phone:937-592-5005
Mailing Address - Fax:937-592-5481
Practice Address - Street 1:1711 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1509
Practice Address - Country:US
Practice Address - Phone:937-592-5005
Practice Address - Fax:937-592-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2278253Medicaid
OH300724335004OtherMEDICAL MUTUAL
OH7986032OtherAETNA
OH300724335004OtherMEDICAL MUTUAL
OH2278253Medicaid
OH4396320001Medicare NSC
OH9318881Medicare PIN