Provider Demographics
NPI:1821173097
Name:DAVIS, CAROLYN J (OD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:JEAN
Other - Last Name:STEELE-DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1861 TOWNE PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2067
Mailing Address - Country:US
Mailing Address - Phone:937-339-7956
Mailing Address - Fax:937-339-6860
Practice Address - Street 1:1861 TOWNE PARK DR STE A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2067
Practice Address - Country:US
Practice Address - Phone:937-339-7956
Practice Address - Fax:937-339-6860
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4494152W00000X
OHT1150152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0981059Medicaid
OHDA0766264Medicare PIN
OH0981059Medicaid
OH0936300001Medicare NSC