Provider Demographics
NPI:1750348868
Name:DAVIS, CHAD (OD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612-0032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 COLLEGE ST
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2714
Practice Address - Country:US
Practice Address - Phone:256-233-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS993TA554152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503429Medicaid
AL4539620001Medicare NSC
AL051503429Medicaid
AL051503429Medicare ID - Type Unspecified