Provider Demographics
NPI:1548593486
Name:DAVIS, NATHAN CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CHRISTOPHER
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N BRIGHTLEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4229
Mailing Address - Country:US
Mailing Address - Phone:919-934-8152
Mailing Address - Fax:919-934-8154
Practice Address - Street 1:1201 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4229
Practice Address - Country:US
Practice Address - Phone:919-934-8152
Practice Address - Fax:919-934-8154
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2147152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2147OtherNC STATE BOARD OF OPTOMETRY LICENSE
NC5912588Medicaid
NC0930KOtherBCBSNC PIN
NC2484603Medicare PIN
NC0930KOtherBCBSNC PIN