Provider Demographics
NPI:1083672851
Name:PICKENS, HAROLD L (OD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:L
Last Name:PICKENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 N 4TH ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1648
Mailing Address - Country:US
Mailing Address - Phone:740-633-2456
Mailing Address - Fax:740-633-2334
Practice Address - Street 1:90 N 4TH ST
Practice Address - Street 2:SUITE 21
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1648
Practice Address - Country:US
Practice Address - Phone:740-633-2456
Practice Address - Fax:740-633-2334
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3689/T792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH001723395OtherBLUE CROSS/BLUE SHIELD
OH0522992Medicaid
OH00000542621OtherANTHEM BLUE CROSS
WV001723395OtherHIGHMARK WV
OH261167905026OtherCARESOURCE
OH3689OtherHEALTH PLAN OF UPPER OV
OH0004571268OtherAETNA
OHP00429729OtherRR MEDICARE
WV1083672851OtherWV WORKERS COMPENSATION
OH731699OtherCOVENTRY
WV9200004000Medicaid
OH$$$$$$$$$005OtherMED MUTUAL OF OHIO
OH$$$$$$$$$-00OtherOHIO WORKERS COMPENSATION
0536304Medicare PIN
OH$$$$$$$$$-00OtherOHIO WORKERS COMPENSATION