Provider Demographics
NPI:1811970445
Name:DAVIS, EDWARD H (OD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:H
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 1:403 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3644
Mailing Address - Country:US
Mailing Address - Phone:585-387-9971
Mailing Address - Fax:
Practice Address - Street 1:6081 RTE 96 S
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425
Practice Address - Country:US
Practice Address - Phone:585-924-2550
Practice Address - Fax:585-924-4399
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100159CSOtherHMO PREFERRED CARE
NY01041381Medicaid
NY4835OtherEYEMED
NY122288OtherCOLE MANAGED CARE PROVIDE
NY122288OtherCOLE MANAGED CARE PROVIDE
NY12095BMedicare ID - Type Unspecified