Active NPI
Tommy Lee Davis II
- Optician
- Roseburg, OR
National Provider Identifier
1487345443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 250110
- Practice address
- 2125 NW Stewart Pkwy
Roseburg, OR 97471-1693 - Phone
- (541) 957-8552
- Fax
- (541) 957-8549
- NPI assigned
- May 18, 2023
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 250110 | OR | Primary |
Addresses
Primary practice location
2125 NW Stewart Pkwy
Roseburg, OR 97471-1693
Mailing address
2125 NW Stewart Pkwy
Roseburg, OR 97471-1693
Phone (541) 957-8552
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 |
|---|---|---|---|
| 250110 | OR | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684368000000",
"number": "1487345443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2125 NW STEWART PKWY",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974711693",
"telephone_number": "541-957-8552",
"fax_number": "541-957-8549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2125 NW STEWART PKWY",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974711693",
"telephone_number": "541-957-8552",
"fax_number": "541-957-8549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "TOMMY",
"middle_name": "LEE",
"name_suffix": "II",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-18",
"last_updated": "2023-05-18",
"certification_date": "2023-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "OR",
"license": "250110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.