Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | WI |
NPI | 1093141483 |
---|---|
Provider Name | Mr. Jeffrey S Davis |
First Address | Madison, WI 53714-2407 |
Second Address | Madison, WI 53714-2407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2013 |
Last Update Date | 14/06/2017 |