Provider Demographics
NPI:1346262177
Name:HARRIS, DARLENE FORSYTH (OD)
Entity Type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:FORSYTH
Last Name:HARRIS
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:PO BOX 2354
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-2354
Mailing Address - Country:US
Mailing Address - Phone:256-235-2020
Mailing Address - Fax:256-235-2018
Practice Address - Street 1:2937 MCCLELLAN BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-2722
Practice Address - Country:US
Practice Address - Phone:256-235-2020
Practice Address - Fax:256-235-2018
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS457TA301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T68927Medicare UPIN