Provider Demographics
NPI:1013018043
Name:HARRIS, RUSK (OD)
Entity Type:Individual
Prefix:DR
First Name:RUSK
Middle Name:
Last Name:HARRIS
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 1:8828 W STATE ROAD 84
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4415
Mailing Address - Country:US
Mailing Address - Phone:954-916-8484
Mailing Address - Fax:954-476-2668
Practice Address - Street 1:8828 W STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4415
Practice Address - Country:US
Practice Address - Phone:954-916-8484
Practice Address - Fax:954-476-2668
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62009230Medicaid
FL62009230Medicaid
FL20612Medicare ID - Type UnspecifiedINDIVIDUAL