Provider Demographics
NPI:1144220872
Name:WARD, HAROLD C (DO)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:C
Last Name:WARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:8490 W HOMOSASSA TRL
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-2705
Mailing Address - Country:US
Mailing Address - Phone:352-628-0123
Mailing Address - Fax:352-628-0918
Practice Address - Street 1:8490 W HOMOSASSA TRL
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2705
Practice Address - Country:US
Practice Address - Phone:352-628-0123
Practice Address - Fax:352-628-0918
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004812207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062073400Medicaid
NJ00647100OtherAMERIHEALTH
FL062073400Medicaid
FL1233080001Medicare PIN
FL1233080002Medicare PIN
FL82690Medicare ID - Type Unspecified
D60702Medicare UPIN