Provider Demographics
NPI:1083813877
Name:LARRY E HARRIS OD
Entity Type:Organization
Organization Name:LARRY E HARRIS OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-235-6550
Mailing Address - Street 1:403 NW LYMAN RD
Mailing Address - Street 2:PO BOX 8659
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66608-1969
Mailing Address - Country:US
Mailing Address - Phone:785-235-6550
Mailing Address - Fax:
Practice Address - Street 1:403 NW LYMAN RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66608-1969
Practice Address - Country:US
Practice Address - Phone:785-235-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS937-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS049639OtherMEDICARE GROUP NUMBER
KS0761573OtherEMPLOYER ID#
KS043977OtherBC-BS INDIVIDUAL #
KS0761573OtherEMPLOYER ID#
KS043977OtherBC-BS INDIVIDUAL #
KS0556280001Medicare NSC