Provider Demographics
NPI:1548564834
Name:HARRIS, KEVIN MCQUITTY (OD, MHA)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MCQUITTY
Last Name:HARRIS
Suffix:
Gender:M
Credentials:OD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1306
Mailing Address - Country:US
Mailing Address - Phone:660-646-3937
Mailing Address - Fax:660-646-4092
Practice Address - Street 1:614 E 9TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2211
Practice Address - Country:US
Practice Address - Phone:660-359-3957
Practice Address - Fax:660-359-4000
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-31
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020640152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO45531018OtherBCBS OF KC
MO45531028OtherBCBS OF KC
MO1548564834OtherBCBS OF MO
MO1548564834Medicaid
MO45531038OtherBCBS OF KC
MO45531048OtherBCBS OF KC
MO1548564834Medicaid
MO45531028OtherBCBS OF KC
MOP00959963Medicare PIN
MOL53000003Medicare PIN
MO45531018OtherBCBS OF KC
MO45531048OtherBCBS OF KC
MO186800003Medicare PIN