Organization
DR. BERNETTA DAVIS OD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNETTA DAVIS-POOLE OD (RESIDENT AGENT)
(410) 523-1224
Entity
Organization
Contact information
Practice address
1804 W NORTH AVE, BALTIMORE, MD 21217-1621
(410) 523-1224
Mailing address
1804 W NORTH AVE, BALTIMORE, MD 21217-1621
(410) 523-1224
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA0696
MD
Other
Enumeration date
01/10/2012
Last updated
03/31/2013
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