Provider Demographics
NPI:1376671792
Name:HARRIS, TRIPHINIA DENELL (OD)
Entity Type:Individual
Prefix:DR
First Name:TRIPHINIA
Middle Name:DENELL
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 1:7885 MAPLE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9350
Mailing Address - Country:US
Mailing Address - Phone:740-549-1331
Mailing Address - Fax:
Practice Address - Street 1:5083 TUTTLE CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-1533
Practice Address - Country:US
Practice Address - Phone:614-717-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3985T184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0522518Medicaid
OHU47126Medicare ID - Type Unspecified