Provider Demographics
NPI:1598844946
Name:HARSHMAN, MICHAEL ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:HARSHMAN
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 1:815 SOUTH 13TH ST.
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733
Mailing Address - Country:US
Mailing Address - Phone:260-724-4111
Mailing Address - Fax:260-724-4188
Practice Address - Street 1:815 SOUTH 13TH ST.
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733
Practice Address - Country:US
Practice Address - Phone:260-724-4111
Practice Address - Fax:260-724-4188
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN62017Medicare UPIN
IN4812770001Medicare NSC