Provider Demographics
NPI:1942782321
Name:DAVIS, NAYAB (OD)
Entity Type:Individual
Prefix:
First Name:NAYAB
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NAYAB
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:76 N GATES AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5532
Practice Address - Country:US
Practice Address - Phone:570-714-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3281152W00000X
NYTUV009660152W00000X
PAOEG003476152W00000X
VA0618003203152W00000X
MTOPT-OPT-LIC-4593152W00000X
FLTPOP116152W00000X
WI3855-35152W00000X
WI21334-875152W00000X
WA61128304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist