Provider Demographics
NPI:1528202389
Name:DAVIS SENIOR CARE LLC
Entity Type:Organization
Organization Name:DAVIS SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-233-2393
Mailing Address - Street 1:PO BOX 7756
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0756
Mailing Address - Country:US
Mailing Address - Phone:252-985-1371
Mailing Address - Fax:252-467-2339
Practice Address - Street 1:110 COLLEGE ST
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2714
Practice Address - Country:US
Practice Address - Phone:256-233-2393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty