Provider Demographics
NPI:1427393925
Name:DAVIDSON OPTOMETRY PC
Entity Type:Organization
Organization Name:DAVIDSON OPTOMETRY PC
Other - Org Name:CENTER FOR VISION AND LEARNING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-628-9100
Mailing Address - Street 1:1000 DES PERES RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2062
Mailing Address - Country:US
Mailing Address - Phone:314-628-9100
Mailing Address - Fax:844-235-0998
Practice Address - Street 1:1000 DES PERES RD STE 105
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2062
Practice Address - Country:US
Practice Address - Phone:314-628-9100
Practice Address - Fax:844-235-0998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOELL, DAVIDSON, & ASSOCAITES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-10
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU80680Medicare UPIN