Provider Demographics
NPI:1619492782
Name:JENNIFER E. DAVIS, OPTOMETRIST, PLLC
Entity Type:Organization
Organization Name:JENNIFER E. DAVIS, OPTOMETRIST, PLLC
Other - Org Name:VISION TECH OPTOMETRY CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-949-7126
Mailing Address - Street 1:221 OSAGE LN STE A
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-9309
Mailing Address - Country:US
Mailing Address - Phone:540-949-7126
Mailing Address - Fax:
Practice Address - Street 1:221 OSAGE LN STE A
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9309
Practice Address - Country:US
Practice Address - Phone:540-949-7126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA013398V88OtherMEDICARE PIN