Provider Demographics
NPI:1083607105
Name:HARRIS, ANTHONY C (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
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 1:1020 GIBSON BAY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3448
Mailing Address - Country:US
Mailing Address - Phone:859-623-3358
Mailing Address - Fax:859-623-8141
Practice Address - Street 1:1020 GIBSON BAY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3448
Practice Address - Country:US
Practice Address - Phone:859-623-3358
Practice Address - Fax:859-623-8141
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1135 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000069289OtherANTHEM
KY7230812OtherCIGNA
KY77011351Medicaid
KY5153686OtherAETNA
KYMH0334285OtherDEA LICENSE
KY77011351Medicaid
KY5153686OtherAETNA
KY7230812OtherCIGNA
KYT54599Medicare UPIN