Provider Demographics
NPI:1659579936
Name:TODD HARRIS PC
Entity Type:Organization
Organization Name:TODD HARRIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-245-3653
Mailing Address - Street 1:3582 ROSS DR
Mailing Address - Street 2:PO BOX 47
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48421-8712
Mailing Address - Country:US
Mailing Address - Phone:810-793-1411
Mailing Address - Fax:
Practice Address - Street 1:555 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4611
Practice Address - Country:US
Practice Address - Phone:810-245-3653
Practice Address - Fax:810-245-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1497851414OtherINDIVIDUAL NPI NUMBER
MION93120Medicare ID - Type UnspecifiedOLD GROUP NUMBER
MI1497851414OtherINDIVIDUAL NPI NUMBER