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Apply to Become a Davis Vision Provider

6 Easy Steps to Expedite the Davis Vision
Provider Application Process
Application Process (All Sections MUST be completed):
1. Fill out one copy of the "Office Information" section of the Vision Care Provider Application for each of your office locations.
2. Fill out a separate copy of the "Practitioner Information" section of the Vision Care Provider Application for each licensed practitioner in your office that will be providing covered services to Davis Vision members.
3. Complete a separate copy of the "Payee Information" section of the Vision Care Provider Application and a W-9 form for each entity that is to receive reimbursement for covered services rendered at your office.
4. Use the "Provider Documents Requirement" Checklist to make sure that copies of all necessary documents are included with your returned, completed application.
5. Review and sign the Letter of Agreement for return with the application.
6. Upon receipt of the completed Vision Care Provider Application and necessary documentation by Davis Vision the credentialing process will be initiated. You will be notified of your credentialing status within 90 days of receipt of the completed application.

Please select your state* from the list below and click the button.
Click on each of the forms that are listed for your state and print out a copy to complete.

*If your state is not in the then list select 'All Others'.

Please note: Submission of the completed Vision Care Plan Provider Application and/or the Davis Vision Inc. Participating Provider Agreement Forms does not constitute acceptance as a Davis Vision Participating Provider. Acceptance as a Participating Provider is contingent upon the determination of geographic need, compliance with all credentialling standards and the execution of the Participating Provider Agreement by Davis Vision.