Active NPI
Roger Davis, OD
- Optometrist
- Bossier City, LA
National Provider Identifier
1457411456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 636
- Practice address
- 2950 E Texas St Ste 302
#24
Bossier City, LA 71111-3259 - Phone
- (318) 742-8896
- Fax
- (318) 742-8898
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 636 | LA | Primary |
Addresses
Primary practice location
2950 E Texas St Ste 302
#24
Bossier City, LA 71111-3259
Mailing address
11103 West Ave
San Antonio, TX 78213-1370
Phone (210) 524-6803
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 636 | LA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457411456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11103 WEST AVE",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782131370",
"telephone_number": "210-524-6803",
"fax_number": "210-524-6587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2950 E TEXAS ST STE 302",
"address_2": "#24",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711113259",
"telephone_number": "318-742-8896",
"fax_number": "318-742-8898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "ROGER",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "LA",
"license": "636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bossier City, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.