Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1352 | NE |
N | 152W00000X | Optometrist | 200T | WY |
NPI | 1013042068 |
---|---|
Provider Name | Devin J Davis |
First Address | Chadron, NE 69337-2313 |
Second Address | Chadron, NE 69337-2313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10026126000 | (05) | NE |
114581900 | (05) | WY |
DS5329 | (02) | NE |
U40778 | (02) | WY |