Provider Demographics
NPI:1407846389
Name:DAVIS, CHARLES H (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:789 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1045
Mailing Address - Country:US
Mailing Address - Phone:330-923-5676
Mailing Address - Fax:330-572-2450
Practice Address - Street 1:789 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1045
Practice Address - Country:US
Practice Address - Phone:330-923-5676
Practice Address - Fax:330-572-2450
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003491207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0547411Medicaid
882724OtherOHE HEALTH PLAN
53303OtherQUALCHOICE
0801309OtherUNITED HEALTHCARE
2289238OtherAETNA
000000028674OtherANTHEM
2289238OtherAETNA
OH0601972Medicare ID - Type Unspecified