Individual provider Active NPI

Larry Jon Davis, OD

  • Optometrist
  • Saint Louis, MO
National Provider Identifier
1174633564
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T02724 Issued in MO
Practice address
7840 Natural Bridge
Patient Care Center
Saint Louis, MO 63121
Phone
(314) 516-5131
Fax
(314) 516-5507
NPI assigned
Aug 30, 2006
Last updated
Jun 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X T02724 MO Primary

Addresses

Primary practice location

7840 Natural Bridge
Patient Care Center
Saint Louis, MO 63121

Mailing address

One University Blvd
Patient Care Center
St Louis, MO 63121
Phone (314) 516-5131

Other practice location 1

3940 Lindell Blvd
Saint Louis, MO 63108-3204
Phone (314) 516-5016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101014000556 MO Practitioner - Optometry 0749472306 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Curators of the University of Missouri Optometrist CurrentSince Sep 2, 2010 Accepting new patients
Curators of the University of Missouri CurrentSince Sep 2, 2010 Accepting new patients
Curators of the University of Missouri Optometrist CurrentSince Sep 2, 2010 Accepting new patients

Locations

1 University Blvd
Saint Louis, MO 63121
Phone (314) 516-5131

1 University Blvd
#115
Saint Louis, MO 63121

1 University Blvd
#153
Saint Louis, MO 63121
Phone (314) 516-5131

3940 Lindell Blvd
Saint Louis, MO 63108
Phone (314) 516-5016

7840 Natural Bridge Rd
Saint Louis, MO 63121
Phone (314) 382-6400

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1174633564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE UNIVERSITY BLVD",
            "address_2": "PATIENT CARE CENTER",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63121",
            "telephone_number": "314-516-5131",
            "fax_number": "314-516-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7840 NATURAL BRIDGE",
            "address_2": "PATIENT CARE CENTER",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63121",
            "telephone_number": "314-516-5131",
            "fax_number": "314-516-5507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3940 Lindell Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631083204",
            "country_code": "US",
            "telephone_number": "314-516-5016",
            "fax_number": "314-535-4741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "LARRY",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.