Davis, Mark Leroy

Davis, Mark Leroy is an sole proprietor health care provider with primary practice located at 3333 Dubuque Ave , Des Moines IA 50317-2767. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Davis, Mark Leroy can be contacted via phone (515) 630-2875.

Contact Information

Primary practice address
3333 Dubuque Ave Des Moines IA 50317-2767
Phone: (515) 630-2875
Fax: (156) 302-8765
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1888 Iowa

Profile Details

NPI number 1881666014
LBN Legal business name Davis, Mark Leroy
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 2nd, 2006
Last updated May 5th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881666014 NPPES
Iowa Other 28826 BLUE CROSS BLUE SHIELD
Iowa Other P00400423 BLUE CROSS BLUE SHIELD
Iowa MEDICAID 0288266 BLUE CROSS BLUE SHIELD

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