Provider Demographics
NPI:1265473383
Name:HARVEY, DENISE M (OD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:M
Last Name:HARVEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S BUSINESS 61 STE F
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-5230
Mailing Address - Country:US
Mailing Address - Phone:573-324-3131
Mailing Address - Fax:573-324-6817
Practice Address - Street 1:1420 S BUSINESS 61 STE F
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-5230
Practice Address - Country:US
Practice Address - Phone:573-324-3131
Practice Address - Fax:573-324-6817
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO313800203Medicaid
MO313800203Medicaid
MO910085617Medicare PIN
MO910085186Medicare PIN