Provider Demographics
NPI:1568503530
Name:DAVIS OPTOMETRY CORPORATION
Entity Type:Organization
Organization Name:DAVIS OPTOMETRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-753-2020
Mailing Address - Street 1:1111 KENNEDY PL
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1266
Mailing Address - Country:US
Mailing Address - Phone:530-753-2020
Mailing Address - Fax:530-753-7441
Practice Address - Street 1:1111 KENNEDY PL
Practice Address - Street 2:SUITE 6
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1266
Practice Address - Country:US
Practice Address - Phone:530-753-2020
Practice Address - Fax:530-753-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08683T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty