Glenn K Davis II MD PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

0101036189 Issued in VA

Legal business name

GLENN K DAVIS II MD PC

Doing business as

Glenn K Davis II MD PC

Practice address

1510 Bob White Blvd
Pulaski, VA 24301-4406

Phone

(540) 980-1965

Fax

(540) 980-0032

NPI assigned

Apr 23, 2008

Last updated

Oct 11, 2013By 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

Susan R Byrd, LPN

Title

Practice Manager

Phone

(540) 980-1965

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• GLENN K DAVIS II MD PC Doing business as

Locations

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381449600000",
    "number": "1881869618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 BOB WHITE BLVD",
            "city": "PULASKI",
            "state": "VA",
            "postal_code": "243014406",
            "telephone_number": "540-980-1965",
            "fax_number": "540-980-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 BOB WHITE BLVD",
            "city": "PULASKI",
            "state": "VA",
            "postal_code": "243014406",
            "telephone_number": "540-980-1965",
            "fax_number": "540-980-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN K DAVIS II MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2013-10-11",
        "status": "A",
        "authorized_official_last_name": "BYRD",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "540-980-1965",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "0101036189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010126991",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010104238",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLENN K DAVIS II MD PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Virginia Marie Fox, RD
• Free Clinic of Pulaski County Inc
• Leslie Geist, BCND
• Catherine Gibson
• Lisa D Glassco, RPH
• Stuart H Goldstein, DO
• William Edgar Hale, R PH
• Linda B Hall, OPTICIAN
• Mary Lynn Hall, RN
• Amy Hammond, SLP

• Ophthalmology Physician in Pulaski, VA
• Providers in Pulaski, VA by specialty
• Ophthalmology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; 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.