Provider Demographics
NPI:1104169366
Name:DAVIS, RONALD TYLER (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:TYLER
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201700503207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology