DR. BRENT RYAN DAVIDSON (NPI# 1437127065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437127065 |
| Entity Type | Individual |
| Full Name | DR. BRENT RYAN DAVIDSON |
| Credential | M.D. |
| Practice Address |
1011 Bowles Ave Suite 415 Fenton MO 63026-2395 |
| Mailing Address |
1011 Bowles Ave Suite 200 Fenton MO 63026-2395 |
| Practice Telephone | 6367171700 |
| Practice Fax Number | 6362034727 |
| Mailing Telephone | 6367171700 |
| Mailing Fax Number | 6362034727 |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2015-01-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 2005009915 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | HEALTH ALLIANCE | 109208 | 01 |
| MO | BLUE CROSS BLUE SHIELD | 199422 | 01 |
| MO | FIRST HEALTH | 5617586 | 01 |
| MO | GROUP HEALTH PLAN | 226523 | 01 |
| HEALTHLINK | 714579 | 01 | |
| IL | BLUECROSS BLUESHIELD | 10032015 | 01 |
| MO | 207319807 | 05 | |
| IL | HEALTHLINK | 714579 | 01 |
| MO | RAILROAD MEDICARE | P00238356 | 01 |
| IL | HEALTH ALLIANCE | 113109 | 01 |
| UNITED HEALTHCARE | 753168118 | 01 | |
| IL | RAILROAD MEDICARE | P00339415 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386163129 | Brent Allen Davidson | Nurse Anesthetist, Certified Registered | 501 20th St Ste 606, Knoxville, TN 37916-1863 | 2017-09-13 |
| 1336216480 | Brent N. Davidson | Obstetrics & Gynecology | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2006-11-30 |
| 1104874197 | Brent William Davidson | Emergency Medicine | 110 S Main St, Hiawassee, GA 30546-3408 | 2006-05-04 |
| Street Address |
1011 BOWLES AVE SUITE 415 |
| City | FENTON |
| State | MO |
| Zip Code | 63026-2395 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710979208 | Cesar Fernando Munoz | Internal Medicine | 1011 Bowles Ave, Ste. 300, Fenton, MO 63026-2395 | 2005-08-19 |
| 1083120208 | Tiffany Shanta Harold | Nurse Practitioner | 1011 Bowles Ave, Fenton, MO 63026-2395 | 2017-12-26 |
| 1093250334 | Laura Ann Rogers | Registered Nurse | 1011 Bowles Ave, Ste 220, Fenton, MO 63026-2395 | 2016-12-22 |
| 1124579966 | Ssm Medical Group Inc. | Orthopaedic Surgery | 1011 Bowles Ave, Suite 400, Fenton, MO 63026-2395 | 2016-10-17 |
| 1699158196 | Diane Denise Block | Nurse Practitioner | 1011 Bowles Ave, Suite 300, Fenton, MO 63026-2395 | 2015-07-01 |
| 1992196992 | Tara Joann Knoepp | Physical Therapist | 1011 Bowles Ave, Suite 150, Fenton, MO 63026-2395 | 2015-02-11 |
| 1093129538 | Elizabeth Anne Rancour | Dermatology | 1011 Bowles Ave, Ste 121, Fenton, MO 63026 | 2014-06-12 |
| 1558799742 | Amanda Nicole Meitz | Nurse Practitioner | 1011 Bowles Ave, Suite 205, Fenton, MO 63026-2395 | 2013-10-24 |
| 1013253699 | Lita Lapins | Nurse Practitioner | 1011 Bowles Ave, Suite 300, Fenton, MO 63026 | 2012-12-30 |
| 1043568280 | Denise P Blackburn | Registered Nurse | 1011 Bowles Ave, Suite G10, Fenton, MO 63026-2395 | 2012-08-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871000372 | Allison Egler | Audiologist | 1011 Bowles Ave Ste 405, Fenton, MO 63026 | 2018-01-05 |
| 1629508213 | Holly Brooks Munson | Massage Therapist | 220 Copper Mountain Dr, Fenton, MO 63026 | 2017-06-15 |
| 1073978862 | Naomi Sharon | Nurse Practitioner | 1101 Bowles Avenue, Suite G50, Fenton, MO 63026 | 2015-12-21 |
| 1871981704 | Celtic Private Care of Il & Mo, LLC | In Home Supportive Care | 1653 Larkin Williams Road, Suite 201, Fenton, MO 63026 | 2014-12-30 |
| 1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
| 1245642420 | Physicians Health Group Medical Inc | General Practice | 960 S. Highway Dr, Fenton, MO 63026 | 2014-05-22 |
| 1598047409 | Kevin Eugene Bruce | Pharmacist | 1210 Sugar Creek, Fenton, MO 63026 | 2011-09-16 |
| 1215186382 | Concentra Health Services, Inc. | Clinic/Center | 128 Matrix Commons Dr., Fenton, MO 63026 | 2008-09-15 |
| 1790954410 | Castlewood Treatment Center LLC | Community/Behavioral Health | 1855 Bowles Ave, Suite 210, Fenton, MO 63026 | 2008-02-27 |
| 1073703617 | Christina R Baeres | Dietitian, Registered | 38 Majestic Ct, Fenton, MO 63026 | 2007-07-30 |
| Find all providers in zip 63026 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467690131 | My Le Shaw | Ophthalmology | 14272 N Fenton Rd, Fenton, MI 48430-1544 | 2009-02-03 |
| 1205072360 | Envision Eye Specialists PC | Ophthalmology | 1011 Bowles Ave, Suite 200, Fenton, MO 63026-2387 | 2008-12-19 |
| 1508020645 | Shana Widick Rose | Ophthalmology | 1011 Bowles Ave, Suite 415, Fenton, MO 63026-2395 | 2008-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780299578 | Heart of America Eye Care Pa | Ophthalmology | 1147 E North Ave, Belton, MO 64012-5105 | 2020-09-09 |
| 1962020644 | Matthew Theodore Hirabayashi | Ophthalmology | University Hospital One Hospital Dr Dc052.00, Columbia, MO 65212-0001 | 2020-07-09 |
| 1508484288 | Travis Parker | Ophthalmology | University Hospital One Hospital Drive Dc 052.00, Columbia, MO 65212-0001 | 2020-07-09 |
| 1003466897 | Mcelhinney Eye Care, Pa | Ophthalmology | 1004 Carondelet Dr Ste 405, Kansas City, MO 64114-4801 | 2019-09-13 |
| 1952965493 | Eric Jiaming Zhang | Ophthalmology | University Hospital One Hospital Dr Dc.052.00, Columbia, MO 65212-0001 | 2019-04-30 |
| 1790265759 | Washington University | Ophthalmology | 4901 Forest Park Ave # 8221, Saint Louis, MO 63108-1495 | 2018-08-20 |
| 1023597127 | Eye Care Pa | Ophthalmology | 1018 W Foxwood Drive, Raymore, MO 64083 | 2018-08-09 |
| 1255716221 | Summit Eye Center, LLC | Ophthalmology | 1621 Nw Blue Parkway, Lees Summit, MO 64086 | 2015-07-20 |
| 1184038986 | Grace L Paley | Ophthalmology | 621 S New Ballas Rd Ste 5006b, Saint Louis, MO 63141-8270 | 2014-06-19 |
| 1871907378 | Daniel Joseph Watson | Ophthalmology | 900 N Highway 67 St, Florissant, MO 63031 | 2014-06-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.