Individual provider Active NPI

Davonna Alexandria Marin, ABOC

  • Optician
  • Elko New Market, MN
National Provider Identifier
1073472957
Registry record updated Jan 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Practice address
9595 Andrew Ave
Elko New Market, MN 55020-4507
Phone
(574) 274-6274
NPI assigned
Jan 16, 2026
Last updated
Jan 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optician 156FX1800X NU Primary

Addresses

Primary practice location

9595 Andrew Ave
Elko New Market, MN 55020-4507

Mailing address

9595 Andrew Ave
Elko New Market, MN 55020-4507
Phone (574) 274-6274

Other identifiers 1

IdentifierTypeStateIssuer
258684OtherMNABOC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1768521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768521600000",
    "number": "1073472957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9595 ANDREW AVE",
            "city": "ELKO NEW MARKET",
            "state": "MN",
            "postal_code": "550204507",
            "telephone_number": "574-274-6274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9595 ANDREW AVE",
            "city": "ELKO NEW MARKET",
            "state": "MN",
            "postal_code": "550204507",
            "telephone_number": "574-274-6274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIN",
        "first_name": "DAVONNA",
        "middle_name": "ALEXANDRIA",
        "name_prefix": "Mrs.",
        "credential": "ABOC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-01-16",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ABOC",
            "identifier": "258684",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elko New Market, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.