Individual
GLENN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1510 BOB WHITE BLVD, PULASKI, VA 24301-4406
(540) 980-1965
(540) 980-0032
Mailing address
1510 BOB WHITE BLVD, PULASKI, VA 24301-4406
(540) 980-1965
(540) 980-0032
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101036189
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010104238
—
VA
05
—
010126991
—
VA
Enumeration date
08/30/2006
Last updated
10/11/2013
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