Provider Demographics
NPI:1700855111
Name:DAVIS, HARRY (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1835
Mailing Address - Country:US
Mailing Address - Phone:937-653-5005
Mailing Address - Fax:937-653-5363
Practice Address - Street 1:888 E COURT ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-1835
Practice Address - Country:US
Practice Address - Phone:937-653-5005
Practice Address - Fax:937-653-5363
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5021-T1898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4396320001OtherADMINSTAR FEDERAL
OH2278253Medicaid
OHOH1898OtherEYEMED
OH410047132OtherRAILROAD MEDICARE
OH23034OtherSPECTERA
OH311811075OtherWORKMAN COMP
OH7986032OtherAETNA
OH33287OtherCOORDINATED VISION CARE
OH7986032OtherAETNA
OH4396320001OtherADMINSTAR FEDERAL
OH33287OtherCOORDINATED VISION CARE