Provider Demographics
NPI:1124372776
Name:HARMS, WILLARD (MD)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:
Last Name:HARMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 TWO NOTCH RD STE 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4385
Mailing Address - Country:US
Mailing Address - Phone:803-264-3873
Mailing Address - Fax:
Practice Address - Street 1:4101 PERCIVAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8320
Practice Address - Country:US
Practice Address - Phone:803-264-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081363207W00000X
SC34702207W00000X
OK11945207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology