Provider Demographics
NPI:1790734499
Name:DAVIS, JAMES O III (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:O
Last Name:DAVIS
Suffix:III
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 1:2615 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2355152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112827722Medicaid
AR0360260001OtherPALMETTO GBA
AR410007229OtherRAIL ROAD MEDICARE
AR49285OtherBLUECROSS
ART20299Medicare UPIN
ART20299Medicare UPIN