Provider Demographics
NPI:1194031484
Name:HARRIS, JEFFREY LIONEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LIONEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 N HAMMES AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8114
Mailing Address - Country:US
Mailing Address - Phone:815-741-3220
Mailing Address - Fax:815-741-3814
Practice Address - Street 1:3033 W JEFFERSON ST STE 101
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5249
Practice Address - Country:US
Practice Address - Phone:815-729-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist