Individual
MR. DOUGLAS JOEL DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
512 S MAIN ST, MOSCOW, ID 83843-2918
(208) 883-3000
Mailing address
512 S MAIN ST, MOSCOW, ID 83843-2918
(208) 883-3000
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO00000689
WA
Other
Enumeration date
10/12/2006
Last updated
11/29/2007
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