Provider Demographics
NPI:1841478369
Name:DAVIS EYEWEAR LLC
Entity type:Organization
Organization Name:DAVIS EYEWEAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-666-7666
Mailing Address - Street 1:32313 VINE ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3341
Mailing Address - Country:US
Mailing Address - Phone:440-943-6858
Mailing Address - Fax:440-943-5871
Practice Address - Street 1:32313 VINE ST
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-3341
Practice Address - Country:US
Practice Address - Phone:440-943-6858
Practice Address - Fax:440-943-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier