Provider Demographics
NPI:1649902925
Name:DAVIS, TONYA RENEA (OPTICIAN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:RENEA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:RENEA
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:143 VALLEJO CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-1437
Mailing Address - Country:US
Mailing Address - Phone:803-608-4918
Mailing Address - Fax:
Practice Address - Street 1:WALMART VISION CENTER
Practice Address - Street 2:7520 GARNERS FERRY RD
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209
Practice Address - Country:US
Practice Address - Phone:803-783-8348
Practice Address - Fax:803-783-0715
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FC0800X, 156FX1800X
462156FC0800X
SC734156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens