Provider Demographics
NPI:1164661542
Name:WAYNE FAMILY VISION, P.C.
Entity Type:Organization
Organization Name:WAYNE FAMILY VISION, P.C.
Other - Org Name:RICHARD H. HARRISON, O.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-427-7773
Mailing Address - Street 1:125 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1317
Mailing Address - Country:US
Mailing Address - Phone:912-427-7773
Mailing Address - Fax:
Practice Address - Street 1:125 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1317
Practice Address - Country:US
Practice Address - Phone:912-427-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty