Organization
DAVIS OPTOMETRY GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN MARY MEDINA (OFFICE MANAGER)
(850) 526-4550
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0574680001
DMERC -C
FL
05
—
078275100
—
FL
Enumeration date
01/02/2007
Last updated
05/15/2009
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