Provider Demographics
NPI:1518189976
Name:DAVIS EYE ASSOCIATES OD, PA
Entity Type:Organization
Organization Name:DAVIS EYE ASSOCIATES OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-765-5350
Mailing Address - Street 1:3316 SILAS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3011
Mailing Address - Country:US
Mailing Address - Phone:336-765-5350
Mailing Address - Fax:336-765-0769
Practice Address - Street 1:3316 SILAS CREEK PKWY
Practice Address - Street 2:DAVIS EYE ASSOCIATES OD PA
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3011
Practice Address - Country:US
Practice Address - Phone:336-765-5350
Practice Address - Fax:336-765-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901453Medicaid
NC7901453Medicaid