Provider Demographics
NPI:1003263070
Name:J MICHAEL HARMON OD AN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:J MICHAEL HARMON OD AN OPTOMETRIC CORPORATION
Other - Org Name:SONOMA EYEWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-578-4200
Mailing Address - Street 1:534 LARKFIELD CTR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7503
Mailing Address - Country:US
Mailing Address - Phone:707-578-4200
Mailing Address - Fax:707-578-5622
Practice Address - Street 1:534 LARKFIELD CTR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-7503
Practice Address - Country:US
Practice Address - Phone:707-578-4200
Practice Address - Fax:707-578-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5535T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619032695Medicare PIN