Provider Demographics
NPI:1275625105
Name:HARRIS, JEFFREY A (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:HARRIS
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 1:6508 WOLLOCHET DR NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8319
Mailing Address - Country:US
Mailing Address - Phone:253-853-3937
Mailing Address - Fax:253-853-3992
Practice Address - Street 1:6508 WOLLOCHET DR NW
Practice Address - Street 2:SUITE 101
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8319
Practice Address - Country:US
Practice Address - Phone:253-853-3937
Practice Address - Fax:253-853-3992
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU44747Medicare UPIN
WAGAB12479Medicare ID - Type UnspecifiedMEDICARE