Provider Demographics
NPI:1811971518
Name:DAVIS, RICK W (OD)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 JAMES EPPS ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-2030
Mailing Address - Country:US
Mailing Address - Phone:417-334-7291
Mailing Address - Fax:417-334-6156
Practice Address - Street 1:1000 JAMES EPPS ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2030
Practice Address - Country:US
Practice Address - Phone:417-334-7291
Practice Address - Fax:417-334-6156
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOT02423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107899OtherBLUE CROSS BLUE SHIELD
T42554Medicare UPIN
MO0420260003Medicare NSC
MO107899OtherBLUE CROSS BLUE SHIELD
MO0420260001Medicare NSC