NPIMap

Organization Active NPI

Harold E Davis & Terry Alan Trust Etal

Doing business as Davis EyeCare Associates

  • Optometrist
  • Oak Lawn, IL
National Provider Identifier
1265621361
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
HAROLD E DAVIS & TERRY ALAN TRUST ETAL
Doing business as
Davis EyeCare Associates
Practice address
4663 W 95TH St
Oak Lawn, IL 60453-2540
Phone
(708) 636-0600
Fax
(708) 636-0606
NPI assigned
Oct 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

Name
Ms. Jason Davis
Title
Administrative Asst.
Phone
(708) 636-0600

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Preferred Provider Organization 305R00000X 046004083 IL
Preferred Provider Organization 305R00000X 046007173 IL
Preferred Provider Organization 305R00000X 046009277 IL

Addresses

Primary practice location

4663 W 95TH St
Oak Lawn, IL 60453-2540

Mailing address

4663 W 95TH St
Oak Lawn, IL 60453-2540
Phone (708) 636-0600

Other practice location 1

600 Ravinia Pl
Orland Park, IL 60462-3759
Phone (708) 349-7571

Other names 1

  • Davis EyeCare Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080625000134 IL Part B Supplier - Clinic/Group Practice 1456422070 Receives reassigned benefits from 4 practitioners
Practice locations: Oak Lawn, IL; Orland Park, IL

National Provider Directory

National Provider Directory

Locations

4663 W 95th St
Oak Lawn, IL 60453
Phone (708) 636-0600

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1265621361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4663 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532540",
            "telephone_number": "708-636-0600",
            "fax_number": "708-636-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4663 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532540",
            "telephone_number": "708-636-0600",
            "fax_number": "708-636-0606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Ravinia Pl",
            "address_purpose": "LOCATION",
            "city": "Orland Park",
            "state": "IL",
            "postal_code": "604623759",
            "country_code": "US",
            "telephone_number": "708-349-7571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HAROLD E DAVIS & TERRY ALAN TRUST ETAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASST.",
        "authorized_official_telephone_number": "708-636-0600",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "046004083",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "046007173",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "046009277",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis EyeCare Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oak Lawn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.