Provider Demographics
NPI:1649237223
Name:HARRIS, ALLISON HATLEY (OD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:HATLEY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ALLISON
Other - Last Name:HATLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:1302 BROWN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4672
Practice Address - Country:US
Practice Address - Phone:252-946-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09691OtherBCBS GROUP #
NC7909344Medicaid
NC09344OtherBCBS PROV #
NC410018564OtherRAILROAD MCARE PROVIDER #
NCDB8258OtherRR MCARE GROUP #
NC246648EOtherMEDICARE GROUP #
NC8909691OtherMEDICAID GROUP #
NC0139010001OtherDMERC GROUP #
NCDB8258OtherRR MCARE GROUP #
NC7909344Medicaid