Michael Davis, O.D.
Individual provider Active NPI Optometrist · Crownpoint, NM
NPI 1689670861 · NPPES record last updated Apr 8, 2025
Key facts
- NPI
- 1689670861
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 12403819-9934 (UT)
- Practice address
- Hwy 371 Junction Hwy 57 RT 9
Crownpoint, NM 87313 - Phone
- (505) 786-5291
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pennsylvania College of Optometry, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- DHHS PHS Naihs Crownpoint Hospital
Practice addresses (Care Compare)
Junction of Hwy 371 Navajo RT 9
Crownpoint, NM 87313-0358
Phone (505) 786-5291
Hospital & facility affiliations
- Crownpoint Healthcare Facility
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081219000403 | TX | Practitioner - Optometry | 9931261294 | Reassigns benefits to 2 organizations |
| I20240812003068 | UT | Practitioner - Optometry | 9931261294 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2154 | CO | MD | Clinical Psychologist |
| 516 | NM | MD | Health Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shoptikal LLC | Optometrist | Current |
Accepting new patients |
| Pueblo Pintado Clinic | Current | Accepting new patients | |
| Shoptikal LLC | Optometrist | Current |
Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Thoreau Clinic | Current |
Accepting new patients | |
| DHHS PHS Naihs Crownpoint Hospital | Current |
Accepting new patients | |
| DHHS,PHS,Naihs, Gallup Indian Medical Center | Current |
Accepting new patients | |
| Shoptikal LLC | Optometrist | Past | Accepting new patients |
Locations
1900 Mark Ave
Gallup, NM 87301
Phone (505) 863-6894
516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326
516 E Nizhoni Blvd
#18
Gallup, NM 87301
306 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 863-5754
3720 Church Rock St
Gallup, NM 87301
Phone (505) 722-2261
2843 S 5600 W
Ste 110
West Valley City, UT 84120
Phone (801) 967-6300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2154 | CO | |
| Optometrist | 152W00000X | 12403819-9934 | UT | Yes |
Addresses
Primary practice location
Hwy 371 Junction Hwy 57 RT 9
Crownpoint, NM 87313
Mailing address
861 S 700 E
Pleasant Grove, UT 84062-2963
Phone (505) 409-8664
Other providers in Crownpoint, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.