Provider Demographics
NPI:1679748149
Name:HAROLD E. MORRILL, JR., O. D.
Entity Type:Organization
Organization Name:HAROLD E. MORRILL, JR., O. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:865-475-8680
Mailing Address - Street 1:741 E BROADWAY BLVD
Mailing Address - Street 2:P. O. BOX 247
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4907
Mailing Address - Country:US
Mailing Address - Phone:865-475-8680
Mailing Address - Fax:865-475-8681
Practice Address - Street 1:741 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4907
Practice Address - Country:US
Practice Address - Phone:865-475-8680
Practice Address - Fax:865-475-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN586332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0140470001Medicare NSC