Provider Demographics
NPI:1447220199
Name:DAVIS, CARRIE BETH (MD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:BETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23250 CHAGRIN BLVD
Mailing Address - Street 2:BLDG #5 SUITE 440
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-514-1864
Mailing Address - Fax:216-514-1867
Practice Address - Street 1:23250 CHAGRIN BLVD
Practice Address - Street 2:BLD 5 STE 440
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5470
Practice Address - Country:US
Practice Address - Phone:216-514-1864
Practice Address - Fax:216-514-1867
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35055662D207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0873247Medicaid
341711241OtherCORP EIN
OH0873247Medicaid
OH0703014Medicare PIN