Provider Demographics
NPI:1578699179
Name:HARRIS, RONALD L (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
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 1:9788 DAMPLER WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80130-6848
Mailing Address - Country:US
Mailing Address - Phone:303-683-8165
Mailing Address - Fax:
Practice Address - Street 1:6675 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80130-3603
Practice Address - Country:US
Practice Address - Phone:303-683-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MHO167177OtherDEA #
T09822Medicare UPIN
4304-3Medicare ID - Type Unspecified