Provider Demographics
NPI:1568436616
Name:HARRISON, PAMELA SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3273
Mailing Address - Country:US
Mailing Address - Phone:254-791-2020
Mailing Address - Fax:254-791-2025
Practice Address - Street 1:1618 CANYON CREEK DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3275
Practice Address - Country:US
Practice Address - Phone:254-791-2020
Practice Address - Fax:254-791-2025
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5172TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039GNOtherBCBS
TX8A1857Medicare ID - Type Unspecified
TX0039GNOtherBCBS