Provider Demographics
NPI:1225030299
Name:HARRISON, LONNY WESLEE (OD)
Entity Type:Individual
Prefix:
First Name:LONNY
Middle Name:WESLEE
Last Name:HARRISON
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 1:681 MCMURRAY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1039
Mailing Address - Country:US
Mailing Address - Phone:412-835-7474
Mailing Address - Fax:412-835-1740
Practice Address - Street 1:681 MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1039
Practice Address - Country:US
Practice Address - Phone:412-835-7474
Practice Address - Fax:412-835-1740
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH0407393OtherDEA#
MH0407393OtherDEA#
138349Medicare ID - Type Unspecified