Organization
GARY DAVIDSON OD INC
Active
Other names
Dr Gary E Davidson, OD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY E DAVIDSON OD (PRESIDENT)
(502) 895-4456
Entity
Organization
Contact information
Practice address
4803 OUTER LOOP DRIVE, LOUISVILLE, KY 40219-3200
(502) 964-7726
(502) 966-9347
Mailing address
734 BROWNS LN, LOUISVILLE, KY 40207-4007
(502) 895-4456
(502) 966-9347
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0886DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042951
KY BLUE SHIELD
KY
01
—
181046
NVA
KY
01
—
410006446
RR MEDICARE
KY
01
—
5310609
AETNA
KY
05
—
77008860
—
KY
01
—
819777
EYEMED
KY
01
—
911200
BLOCK VISION
KY
01
—
T54705
UPIN
KY
01
—
ZKY33088
INGENIX
KY
Enumeration date
01/19/2012
Last updated
01/19/2012
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