Provider Demographics
NPI:1639150527
Name:HARMON, DAVID E
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:HARMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N HENRY ST # 1088
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4626
Mailing Address - Country:US
Mailing Address - Phone:423-586-9601
Mailing Address - Fax:423-586-9050
Practice Address - Street 1:131 N HENRY ST # 1088
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4626
Practice Address - Country:US
Practice Address - Phone:423-586-9601
Practice Address - Fax:423-586-9050
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3599961Medicaid
U56430Medicare UPIN
TN1094480001Medicare NSC
TN3599961Medicaid