Provider Demographics
NPI:1558564401
Name:DAVIS, CONNIE ALLEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:ALLEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3291 BEL AIR MALL
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3207
Mailing Address - Country:US
Mailing Address - Phone:251-476-2015
Mailing Address - Fax:251-478-5360
Practice Address - Street 1:3291 BEL AIR MALL
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3207
Practice Address - Country:US
Practice Address - Phone:251-476-2015
Practice Address - Fax:251-478-5360
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-725-TA-306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU25356Medicare UPIN
AL051517897DAVMedicare PIN