Provider Demographics
NPI:1407998636
Name:DAVISSON, DONALD G (OD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:G
Last Name:DAVISSON
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 1:175 BEASLEY DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2841
Mailing Address - Country:US
Mailing Address - Phone:615-441-3908
Mailing Address - Fax:615-441-3436
Practice Address - Street 1:175 BEASLEY DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2841
Practice Address - Country:US
Practice Address - Phone:615-441-3908
Practice Address - Fax:615-441-3436
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNSPECTERAOtherSPECTERA INSURANCE
TN359-8669Medicare ID - Type UnspecifiedMEDICARE NUMBER
TNSPECTERAOtherSPECTERA INSURANCE