Provider Demographics
NPI:1104828375
Name:SULZBERGER, HARRY M (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:M
Last Name:SULZBERGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 KEENE ST
Mailing Address - Street 2:STE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8104
Mailing Address - Country:US
Mailing Address - Phone:573-874-2030
Mailing Address - Fax:573-449-0253
Practice Address - Street 1:500 KEENE ST
Practice Address - Street 2:STE 103
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8104
Practice Address - Country:US
Practice Address - Phone:573-874-2030
Practice Address - Fax:573-449-0253
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOT02082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0270770001OtherNORIDIAN-DMERC
MO108476OtherBC/BS
MO0270770001OtherNORIDIAN-DMERC