Provider Demographics
NPI:1831289552
Name:GEOFFREY V. DAVIS, M.D. INC.
Entity Type:Organization
Organization Name:GEOFFREY V. DAVIS, M.D. INC.
Other - Org Name:AIEA VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:V
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-487-8993
Mailing Address - Street 1:98-211 PALI MOMI ST STE 820
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4340
Mailing Address - Country:US
Mailing Address - Phone:808-487-8993
Mailing Address - Fax:808-486-9409
Practice Address - Street 1:98-211 PALI MOMI ST STE 820
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4340
Practice Address - Country:US
Practice Address - Phone:808-487-8993
Practice Address - Fax:808-486-9409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2921207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBM084XOtherPTAN
HIHGDAVISMedicare PIN
HIBM084XOtherPTAN