Individual
DR. MARK LEROY DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3333 DUBUQUE AVE, DES MOINES, IA 50317-2767
(515) 630-2875
(156) 302-8765
Mailing address
3333 DUBUQUE AVE, DES MOINES, IA 50317-2767
(515) 630-2875
(515) 630-2876
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1888
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0288266
—
IA
01
—
28826
BLUE CROSS BLUE SHIELD
IA
01
—
P00400423
MEDICARE RAILROAD
IA
Enumeration date
02/02/2006
Last updated
05/05/2021
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