Provider Demographics
NPI:1669511861
Name:HARPER, ALYSON ESTHER (OD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:ESTHER
Last Name:HARPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 NE HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-4424
Mailing Address - Country:US
Mailing Address - Phone:541-996-2020
Mailing Address - Fax:541-996-4787
Practice Address - Street 1:2702 NE HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4424
Practice Address - Country:US
Practice Address - Phone:541-996-2020
Practice Address - Fax:541-996-4787
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1998ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR052386Medicaid
OR052386Medicaid
OR1252310001Medicare NSC
ORR0000PHGKWMedicare PIN