Gary Davidson OD Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

0886DT Issued in KY

Legal business name

GARY DAVIDSON OD INC

Practice address

4803 Outer Loop Drive
Louisville, KY 40219-3200

Phone

(502) 964-7726

Fax

(502) 966-9347

NPI assigned

Jan 19, 2012

Last updated

Jan 19, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gary E Davidson, OD

Title

President

Phone

(502) 895-4456

Specialties & licenses 1

Addresses

Other identifiers 10

Other names 1

• Dr Gary E Davidson, OD Former legal business name

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

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326931200000",
    "number": "1629349857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "734 BROWNS LN",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074007",
            "telephone_number": "502-895-4456",
            "fax_number": "502-966-9347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4803 OUTER LOOP DRIVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402193200",
            "telephone_number": "502-964-7726",
            "fax_number": "502-966-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY DAVIDSON OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-19",
        "last_updated": "2012-01-19",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-895-4456",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "0886DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "410006446",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "819777",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY BLUE SHIELD",
            "identifier": "000000042951",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5310609",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE VISION SERVICES",
            "identifier": "819777",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "181046",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INGENIX",
            "identifier": "ZKY33088",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77008860",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK VISION",
            "identifier": "911200",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "T54705",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Gary E Davidson, OD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• John Joseph Garvey IV
• Brent Daniel Garvin
• Micah Garvin, BCBA
• Steven A. Garvin
• Taylor-Leigh Garvin, APRN
• Gary L Reasor, MD P.S.C (Metro Pain Associates)
• Jennifer Gary
• Gabriela Garza Covarrubias, DDS
• Krista Maria Garza, N.P.
• Loren Garza

• Optometrist in Louisville, KY
• Providers in Louisville, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; 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.