Provider Demographics
NPI:1285626259
Name:DAVIE, LAURIE RENE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:RENE
Last Name:DAVIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 KIETZKE LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3604
Mailing Address - Country:US
Mailing Address - Phone:775-829-5685
Mailing Address - Fax:
Practice Address - Street 1:2295 KIETZKE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3604
Practice Address - Country:US
Practice Address - Phone:775-829-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV612152W00000X
CA12840T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFK321ZOtherMEDICARE PTAN
12257005OtherCAQH