Provider Demographics
NPI:1316012107
Name:ARCHIBALD R MORRIS OD
Entity Type:Organization
Organization Name:ARCHIBALD R MORRIS OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIBALD
Authorized Official - Middle Name:REGIS
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-472-9670
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000628152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009711820002Medicaid
PA391971OtherNVA
PA50704OtherDAVIS VISION
PAPA06285OtherVBA
PA506722OtherHIGHMARK
PA208734OtherUPMC
PA5153452OtherAETNA
PADG2847OtherPALMETTO GBA RAILROADERS
PAAM15624OtherSPECTERA
PA1361126OtherFUNDS
PA50704OtherDAVIS VISION
PA059908Medicare ID - Type Unspecified