Provider Demographics
NPI:1457442857
Name:DAVIS, JEANMARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JEANMARIE
Middle Name:
Last Name:DAVIS
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 1:4842 SW 155TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5642
Mailing Address - Country:US
Mailing Address - Phone:954-816-2424
Mailing Address - Fax:954-322-1138
Practice Address - Street 1:1558 W 68TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3810
Practice Address - Country:US
Practice Address - Phone:305-556-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4066Medicare ID - Type Unspecified
FLV03176Medicare UPIN