Provider Demographics
NPI:1457310203
Name:HARKEMA, DAVID RYAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RYAN
Last Name:HARKEMA
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 1:38 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-1138
Mailing Address - Country:US
Mailing Address - Phone:616-887-8811
Mailing Address - Fax:616-887-8789
Practice Address - Street 1:38 N UNION ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-1138
Practice Address - Country:US
Practice Address - Phone:616-887-8811
Practice Address - Fax:616-887-8789
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI49010003629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI410047869OtherRAILROAD MEDICARE
MI5565450001OtherDME MAC MEDICARE
MI410047869OtherRAILROAD MEDICARE
MIU50764Medicare UPIN
MI5565450001OtherDME MAC MEDICARE