Provider Demographics
NPI:1982860144
Name:DAVIS, JOHN MARCUS (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARCUS
Last Name:DAVIS
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 1:2615 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7405
Mailing Address - Country:US
Mailing Address - Phone:870-793-4400
Mailing Address - Fax:870-793-4000
Practice Address - Street 1:2615 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7405
Practice Address - Country:US
Practice Address - Phone:870-793-4400
Practice Address - Fax:870-793-4000
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist