Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618001827 | VA |
NPI | 1003956673 |
---|---|
Provider Name | Dr. Richard Michael Davidson |
First Address | Mc Lean, VA 22102-4525 |
Second Address | Mc Lean, VA 22102-4525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 28/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T-87936 | (02) | VA |