Provider Demographics
NPI:1689110785
Name:DAVIDSON, JENNIFER (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WARNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7300 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5312
Mailing Address - Country:US
Mailing Address - Phone:305-665-2353
Mailing Address - Fax:305-665-2853
Practice Address - Street 1:7300 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5312
Practice Address - Country:US
Practice Address - Phone:305-665-2353
Practice Address - Fax:305-665-2853
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003220152W00000X
FL5304152W00000X
FLOPC5304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist