Provider Demographics
NPI:1740343599
Name:DRS. DAVIS AND REEVES OPTOMETRISTS INC
Entity type:Organization
Organization Name:DRS. DAVIS AND REEVES OPTOMETRISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-963-0173
Mailing Address - Street 1:3429 N TWIN CITY HWY
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2102
Mailing Address - Country:US
Mailing Address - Phone:409-963-0173
Mailing Address - Fax:409-962-8405
Practice Address - Street 1:3429 N TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2102
Practice Address - Country:US
Practice Address - Phone:409-963-0173
Practice Address - Fax:409-962-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01812TG152W00000X
TX02064T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E57HMedicare PIN
TX0281850001Medicare NSC