Provider Demographics
NPI:1366651606
Name:TERRY J HARRISON OD PC
Entity Type:Organization
Organization Name:TERRY J HARRISON OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-647-2153
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0490
Mailing Address - Country:US
Mailing Address - Phone:918-647-2153
Mailing Address - Fax:918-647-8711
Practice Address - Street 1:1230 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-0490
Practice Address - Country:US
Practice Address - Phone:918-647-2153
Practice Address - Fax:918-647-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762410AMedicaid
OK100762410AMedicaid
OK6111150001Medicare NSC