Individual
DAVIS MARSHALL STALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
330 W DIMOND BLVD, ANCHORAGE, AK 99515-1903
(907) 267-7102
(907) 349-7039
Mailing address
330 W DIMOND BLVD, ANCHORAGE, AK 99515-1903
(907) 267-7102
(907) 349-7039
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
106884
AK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920086076
TAX ID
—
Enumeration date
02/02/2011
Last updated
04/04/2023
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