Provider Demographics
NPI:1508858267
Name:HARRIS, DANIEL C (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
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 1:300 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7865
Mailing Address - Country:US
Mailing Address - Phone:937-681-4956
Mailing Address - Fax:513-360-0133
Practice Address - Street 1:9998 KINGS AUTO MALL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-8234
Practice Address - Country:US
Practice Address - Phone:513-549-4140
Practice Address - Fax:513-683-7965
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0896679Medicaid
OHU29955Medicare UPIN
OH0457830001Medicare NSC
OH0896679Medicaid