Provider Demographics
NPI:1508001272
Name:EDWIN A. DAVISON, JR.
Entity Type:Organization
Organization Name:EDWIN A. DAVISON, JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:518-584-5821
Mailing Address - Street 1:615 MAPLE AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5632
Mailing Address - Country:US
Mailing Address - Phone:518-584-5821
Mailing Address - Fax:518-583-9404
Practice Address - Street 1:615 MAPLE AVE
Practice Address - Street 2:STE 3
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5632
Practice Address - Country:US
Practice Address - Phone:518-584-5821
Practice Address - Fax:518-583-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182490332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4964430001Medicare NSC