Provider Demographics
NPI:1396830840
Name:HARRIS, ANDREW JASON (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JASON
Last Name:HARRIS
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 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:499 GREENVILLE BLVD SE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6734
Practice Address - Country:US
Practice Address - Phone:252-756-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001599152W00000X
NC2026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010320445Medicaid
NC5905646Medicaid
VA239958OtherANTHEM PROVIDER NUMBER
NC093VGOtherBCBS PROV #
NC093VGOtherBCBS PROV #
NC2474212Medicare PIN
VA239958OtherANTHEM PROVIDER NUMBER
VA011475M40Medicare PIN
V10549Medicare UPIN