Provider Demographics
NPI:1316011158
Name:MORRIS, ARCHIBALD REGIS (OD)
Entity Type:Individual
Prefix:
First Name:ARCHIBALD
Middle Name:REGIS
Last Name:MORRIS
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 1:125 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-2081
Mailing Address - Country:US
Mailing Address - Phone:814-472-9670
Mailing Address - Fax:814-472-9704
Practice Address - Street 1:125 MANOR DR
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-2081
Practice Address - Country:US
Practice Address - Phone:814-472-9670
Practice Address - Fax:814-472-9704
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000628152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087634OtherBLUECROSS BLUE SHIELD
PA1361126OtherFUNDS
PA50704OtherDAVIS VISION
PA208734OtherUPMC
PAPA6285OtherVISION BENEFITS OF AMERIC
PA391971OtherNVA
PA410004716OtherPALMETTO GBA RAILROAD MED
PA0009711820002Medicaid
PA5153452OtherAETNA
PAAM15624OtherSPECTERA
PA1361126OtherFUNDS
PA410004716OtherPALMETTO GBA RAILROAD MED