Provider Demographics
NPI:1225071343
Name:HARRISON, GREGORY WADE (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:WADE
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 1:7001 W PARKER RD
Mailing Address - Street 2:#918
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8614
Mailing Address - Country:US
Mailing Address - Phone:972-306-7705
Mailing Address - Fax:
Practice Address - Street 1:1900 PRESTON RD
Practice Address - Street 2:SUITE 265
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5175
Practice Address - Country:US
Practice Address - Phone:972-519-0006
Practice Address - Fax:972-519-0669
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04019T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20119299OtherDPS
20119299OtherDPS
MH0668799OtherDEA