Provider Demographics
NPI:1356879944
Name:CAPACCIOLI, DAVIS (OD)
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:
Last Name:CAPACCIOLI
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 1:3710 MAIN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4033
Mailing Address - Country:US
Mailing Address - Phone:970-403-5655
Mailing Address - Fax:970-403-5964
Practice Address - Street 1:3710 MAIN AVE STE 203
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4033
Practice Address - Country:US
Practice Address - Phone:970-403-5655
Practice Address - Fax:970-403-5964
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1942449517OtherLEE ANN HOVEN OD PC