Provider Demographics
NPI:1720269871
Name:HARRY DAVIS O.D. , INC
Entity Type:Organization
Organization Name:HARRY DAVIS O.D. , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-653-5005
Mailing Address - Street 1:888 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1835
Mailing Address - Country:US
Mailing Address - Phone:937-653-5005
Mailing Address - Fax:937-653-5363
Practice Address - Street 1:888 E COURT ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-1835
Practice Address - Country:US
Practice Address - Phone:937-653-5005
Practice Address - Fax:937-653-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300724335004OtherMEDICAL MUTUAL
OH7986032OtherAETNA
OH2278253Medicaid
OH9318882Medicare PIN