Provider Demographics
NPI:1477738649
Name:DARLENE FORSTYH HARRIS OD
Entity Type:Organization
Organization Name:DARLENE FORSTYH HARRIS OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:FORSYTH
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-235-2020
Mailing Address - Street 1:2937 MCCLELLAN BLVD
Mailing Address - Street 2:PO BOX 2354
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201
Mailing Address - Country:US
Mailing Address - Phone:256-235-2020
Mailing Address - Fax:256-235-2018
Practice Address - Street 1:2937 MCCLELLAN BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201
Practice Address - Country:US
Practice Address - Phone:256-235-2020
Practice Address - Fax:256-235-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5457TA301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058416Medicaid
ALT68927Medicare UPIN