Provider Demographics
NPI:1689733586
Name:HARKINS, JOSEPH EDWIN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWIN
Last Name:HARKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:KIMBROUGH AMBULATORY CARE CENTER
Mailing Address - Street 2:2480 LLEWELLYN AVE
Mailing Address - City:FT. MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755
Mailing Address - Country:US
Mailing Address - Phone:301-677-8376
Mailing Address - Fax:301-677-8077
Practice Address - Street 1:KIMBROUGH AMBULATORY CARE CENTER
Practice Address - Street 2:2480 LLEWELLYN AVE
Practice Address - City:FT. MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755
Practice Address - Country:US
Practice Address - Phone:301-677-8376
Practice Address - Fax:301-677-8077
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-007890-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist