Provider Demographics
NPI:1720037914
Name:DR. JAMES O. DAVIS III O.D.P.A.
Entity Type:Organization
Organization Name:DR. JAMES O. DAVIS III O.D.P.A.
Other - Org Name:BATESVILLE EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:OD OPTOMETRIC PHYSIC
Authorized Official - Phone:870-793-4400
Mailing Address - Street 1:2615 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7405
Mailing Address - Country:US
Mailing Address - Phone:870-793-4400
Mailing Address - Fax:870-793-4000
Practice Address - Street 1:2615 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7405
Practice Address - Country:US
Practice Address - Phone:870-793-4400
Practice Address - Fax:870-793-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPC-102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C102OtherBLUECROSS GROUP
ARCB6489OtherRAILROAD MEDICARE
AR0360260001Medicare NSC
AR5C102OtherBLUECROSS GROUP
AR49285C102Medicare ID - Type UnspecifiedMEDICARE GROUP