Provider Demographics
NPI:1003920653
Name:DENISON, HARRY R (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:R
Last Name:DENISON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-0725
Mailing Address - Country:US
Mailing Address - Phone:870-352-2167
Mailing Address - Fax:870-352-8883
Practice Address - Street 1:312 N SPRING ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-3318
Practice Address - Country:US
Practice Address - Phone:870-352-2167
Practice Address - Fax:870-352-8883
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102066722Medicaid
ART20220Medicare UPIN
AR102066722Medicaid