Basic Information
| Provider Information | |||||||||
| NPI: | 1053338541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIDSON | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 LORD BALTIMORE DR | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212442613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433162101 | ||||||||
| FaxNumber: | 4102656068 | ||||||||
| Practice Location | |||||||||
| Address1: | 17522 HAWTHORNE BLVD | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905043110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102142970 | ||||||||
| FaxNumber: | 3102145132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT 6196 TPA | CA | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 2414 | TX | N | Eye and Vision Services Providers | Optometrist |
No ID Information.