Provider Demographics
NPI:1629440706
Name:HARBOR OPHTHALMOLOGY, PLLC
Entity Type:Organization
Organization Name:HARBOR OPHTHALMOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/ PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLODNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-784-1121
Mailing Address - Street 1:33920 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 275
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2676
Mailing Address - Country:US
Mailing Address - Phone:727-784-1121
Mailing Address - Fax:727-781-4788
Practice Address - Street 1:33920 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 275
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2676
Practice Address - Country:US
Practice Address - Phone:727-784-1121
Practice Address - Fax:727-781-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 33861332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
7518580001OtherNSC
FLIG845AOtherPTAN