Provider Demographics
NPI:1265663769
Name:RONALD LEE HARRIS
Entity Type:Organization
Organization Name:RONALD LEE HARRIS
Other - Org Name:SONOMA EYE CARE OPTOMETRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-585-2020
Mailing Address - Street 1:6040 COMMERCE BLVD
Mailing Address - Street 2:STE. 109
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2181
Mailing Address - Country:US
Mailing Address - Phone:707-585-2020
Mailing Address - Fax:707-585-2563
Practice Address - Street 1:6040 COMMERCE BLVD
Practice Address - Street 2:STE. 109
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2181
Practice Address - Country:US
Practice Address - Phone:707-585-2020
Practice Address - Fax:707-585-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04916T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0049161Medicaid
CA1310750001Medicare NSC
CASD0049161Medicare PIN
CAT09822Medicare UPIN