Individual
THADDEUS DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
610 E BASELINE RD STE C3, PHOENIX, AZ 85042-6536
(602) 269-9771
(602) 268-0899
Mailing address
955 W SOUTHERN AVE STE 101, MESA, AZ 85210-4903
(480) 961-1865
(480) 893-8172
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD61467516
WA
152W00000X
Optometrist
ODP-100630
ID
152W00000X
Optometrist
Primary
OPT-00779
AZ
Other
Enumeration date
06/27/2023
Last updated
05/24/2024
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