Individual
SUSAN ELIZABETH DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
224 E MAIN ST, MARENGO, IA 52301-1511
(319) 642-3311
(319) 642-7111
Mailing address
PO BOX 204, MARENGO, IA 52301-0204
(319) 642-3311
(319) 642-7111
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1641
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0145813
—
IA
Enumeration date
12/29/2005
Last updated
06/16/2008
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