Individual
DR. BERNETTA WINFRED DAVIS-POOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1804 WEST NORTH AVENUE, BALTIMORE, MD 21217
(410) 523-1224
(410) 747-6563
Mailing address
1804 WEST NORTH AVENUE, BALTIMORE, MD 21217
(410) 523-1224
(410) 728-1804
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA0696
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3325172 00
—
MD
05
—
790418501
—
MD
05
—
790418504
—
MD
01
—
P00870154
MEDICARE PROVIDER #
—
Enumeration date
09/29/2006
Last updated
08/15/2016
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