Provider Demographics
NPI:1801321120
Name:DAVIS, JASON (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 SW IMMANUEL DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2738
Mailing Address - Country:US
Mailing Address - Phone:772-283-1191
Mailing Address - Fax:772-283-4899
Practice Address - Street 1:2660 SW IMMANUEL DR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2738
Practice Address - Country:US
Practice Address - Phone:772-283-1191
Practice Address - Fax:772-283-4899
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist