Provider Demographics
NPI:1467932723
Name:DR RACHELLE DAVIS OPTOMETRIST PLLC
Entity Type:Organization
Organization Name:DR RACHELLE DAVIS OPTOMETRIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-627-1125
Mailing Address - Street 1:703 S VAN BUREN RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5321
Mailing Address - Country:US
Mailing Address - Phone:336-627-1125
Mailing Address - Fax:336-627-1228
Practice Address - Street 1:703 S VAN BUREN RD BLDG 2
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5321
Practice Address - Country:US
Practice Address - Phone:336-627-1125
Practice Address - Fax:336-627-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty