Provider Demographics
NPI:1700216090
Name:ALL EYE CARE AT DAVIS, INC
Entity Type:Organization
Organization Name:ALL EYE CARE AT DAVIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DZENANA
Authorized Official - Middle Name:
Authorized Official - Last Name:IDRIZOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:603-566-7463
Mailing Address - Street 1:63 STATION LNDG
Mailing Address - Street 2:ATT. DR DZENANA IDRIZOVIC
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5192
Mailing Address - Country:US
Mailing Address - Phone:603-566-7463
Mailing Address - Fax:
Practice Address - Street 1:63 STATION LNDG
Practice Address - Street 2:ATT. DR DZENANA IDRIZOVIC
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5192
Practice Address - Country:US
Practice Address - Phone:603-566-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty