Individual
JEFFREY K. DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2922 JEFFERSON ST, MARIANNA, FL 32446-3448
(850) 526-4550
(850) 526-1200
Mailing address
2922 JEFFERSON ST, MARIANNA, FL 32446-3448
(850) 526-4550
(850) 526-1200
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC1631
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078183500
—
FL
01
—
19997
BCBS
FL
01
—
410000203
RAILROAD MEDICARE
FL
01
—
K6143
PC-ACE PRO 32
FL
Enumeration date
02/28/2006
Last updated
01/04/2012
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