Provider Demographics
NPI:1902382146
Name:DAVIS OPHTHALMOLOGY, PLLC
Entity Type:Organization
Organization Name:DAVIS OPHTHALMOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:336-838-5121
Mailing Address - Street 1:408 8TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4167
Mailing Address - Country:US
Mailing Address - Phone:336-838-5121
Mailing Address - Fax:336-667-5756
Practice Address - Street 1:408 8TH ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4167
Practice Address - Country:US
Practice Address - Phone:336-838-5121
Practice Address - Fax:336-667-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201700503207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14007221OtherCAQH
1456663889OtherPECOS
NC19SQDOtherBLUE CROSS BLUE SHIELD
FD6625199OtherDEA