Provider Demographics
NPI:1457486854
Name:HARRIS, JOEY LEE (OD)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JOEY
Other - Middle Name:L
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2170 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2999
Mailing Address - Country:US
Mailing Address - Phone:910-295-2100
Mailing Address - Fax:910-295-5339
Practice Address - Street 1:2170 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2999
Practice Address - Country:US
Practice Address - Phone:910-295-2100
Practice Address - Fax:910-295-5339
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0929WOtherBCBS
NC56162OtherMEDCOST
NC24120OtherCIGNA OPTICARE
SCDN1795Medicaid
NC89093G6Medicaid
NC2471775EMedicare PIN
NC0929WOtherBCBS
NC24120OtherCIGNA OPTICARE
NC2471775CMedicare PIN
NC56162OtherMEDCOST