Provider Demographics
NPI:1639112162
Name:HARROLD, DENNIS BLAIR (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:BLAIR
Last Name:HARROLD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2325 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2529
Mailing Address - Country:US
Mailing Address - Phone:252-451-5300
Mailing Address - Fax:252-451-5330
Practice Address - Street 1:819 TIFFANY BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1812
Practice Address - Country:US
Practice Address - Phone:252-972-2020
Practice Address - Fax:252-977-7241
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0854152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09364OtherBCBSNC INDIVIDUAL NUMBER