Dr. Bernetta Davis OD, PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA0696 Issued in MD

Legal business name

DR. BERNETTA DAVIS OD, PLLC

Practice address

1804 W North Ave
Baltimore, MD 21217-1621

Phone

(410) 523-1224

NPI assigned

Jan 10, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Bernetta Davis-Poole, OD

Title

Resident Agent

Phone

(410) 523-1224

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364688000000",
    "number": "1942570874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 W NORTH AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212171621",
            "telephone_number": "410-523-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 W NORTH AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212171621",
            "telephone_number": "410-523-1224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. BERNETTA DAVIS OD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-10",
        "last_updated": "2013-03-31",
        "status": "A",
        "authorized_official_last_name": "DAVIS-POOLE",
        "authorized_official_first_name": "BERNETTA",
        "authorized_official_title_or_position": "RESIDENT AGENT",
        "authorized_official_telephone_number": "410-523-1224",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA0696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.