Provider Demographics
NPI:1528012994
Name:HARVEY, JEFFREY A (OD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:HARVEY
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 1:703 ROSEANNE DR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-1551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703 ROSEANNE DR
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-1551
Practice Address - Country:US
Practice Address - Phone:252-527-8804
Practice Address - Fax:252-527-4379
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890935WMedicaid
NCU56071OtherUPIN
NC0935WOtherBCBS
NC2469591Medicare PIN