Provider Demographics
NPI:1225024235
Name:HARSHBERGER, DAVID W (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:HARSHBERGER
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 1:1142 S BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-1546
Mailing Address - Country:US
Mailing Address - Phone:304-455-6268
Mailing Address - Fax:304-455-6498
Practice Address - Street 1:1142 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1546
Practice Address - Country:US
Practice Address - Phone:304-455-6268
Practice Address - Fax:304-455-6498
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV735-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HA0812956Medicare ID - Type Unspecified
T32591Medicare UPIN