Individual
GARY L DAVISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4647 ZION AVE, SAN DIEGO, CA 92120-2507
(619) 528-5000
Mailing address
4647 ZION AVE, SAN DIEGO, CA 92120-2507
(619) 528-5000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT7442TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
320057
MEDICARE PART A
NM
01
—
HSZ189
MEDICARE PART B
NM
05
—
K3543
—
NM
Enumeration date
03/21/2007
Last updated
05/05/2014
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