Provider Demographics
NPI:1770765497
Name:MARK K DAVIS & ASSOCIATES, PA
Entity type:Organization
Organization Name:MARK K DAVIS & ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-521-2085
Mailing Address - Street 1:6450 NW LOOP 410
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-4209
Mailing Address - Country:US
Mailing Address - Phone:210-521-2085
Mailing Address - Fax:210-509-0962
Practice Address - Street 1:6450 NW LOOP 410
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4209
Practice Address - Country:US
Practice Address - Phone:210-521-2085
Practice Address - Fax:210-509-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3460TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000072FCOtherBCBS
TXT12925Medicare UPIN
TX00000072FCOtherBCBS