Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OEG003683 | PA |
Y | 152W00000X | Optometrist | TUV009334-01 | NY |
NPI | 1013535798 |
---|---|
Provider Name | Laura Ann Davis |
First Address | Syracuse, NY 13202-2292 |
Second Address | Syracuse, NY 13202-2292 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2020 |
Last Update Date | 15/12/2021 |