Provider Demographics
NPI:1881026003
Name:DAVIDSON, JOSHUA R (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:R
Last Name:DAVIDSON
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 1:14415 VILLA CARRE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7800
Mailing Address - Country:US
Mailing Address - Phone:989-225-6821
Mailing Address - Fax:
Practice Address - Street 1:1004 LOUISIANA HWY. 30
Practice Address - Street 2:SUITE A
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4531
Practice Address - Country:US
Practice Address - Phone:225-644-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1655-689T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist