Provider Demographics
NPI:1750351649
Name:DAVIS, STEVEN KENNETH (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KENNETH
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 RAINTREE CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-9145
Mailing Address - Country:US
Mailing Address - Phone:910-347-7263
Mailing Address - Fax:
Practice Address - Street 1:647 WAYAH ST
Practice Address - Street 2:DEPT OF VETERANS AFFAIRS FRANKLIN CBOC
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-3390
Practice Address - Country:US
Practice Address - Phone:828-369-1781
Practice Address - Fax:828-369-1809
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2080152W00000X
SC1426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist