Provider Demographics
NPI:1235327396
Name:JACQUELINE G. DAVIS OPTOMETRIST INC
Entity Type:Organization
Organization Name:JACQUELINE G. DAVIS OPTOMETRIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-471-9005
Mailing Address - Street 1:2696 CROSSROADS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3442
Mailing Address - Country:US
Mailing Address - Phone:614-471-9005
Mailing Address - Fax:614-471-2791
Practice Address - Street 1:2696 CROSSROADS PLAZA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3442
Practice Address - Country:US
Practice Address - Phone:614-471-9005
Practice Address - Fax:614-471-2791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-13
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty