Basic Information
| Provider Information | |||||||||
| NPI: | 1104981042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVYDOVA | ||||||||
| FirstName: | YELENA | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8692 LAKE ASHMERE DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921193203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199571616 | ||||||||
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| Practice Location | |||||||||
| Address1: | 539 PARKWAY PLZ | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920202532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194410138 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 06/24/2008 | ||||||||
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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 | 12562T | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.