Provider Demographics
NPI:1710064258
Name:HARVEY, TED JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:JAMES
Last Name:HARVEY
Suffix:
Gender:M
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:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-0637
Mailing Address - Country:US
Mailing Address - Phone:308-324-5631
Mailing Address - Fax:308-324-3096
Practice Address - Street 1:801 N GRANT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-0637
Practice Address - Country:US
Practice Address - Phone:308-324-5631
Practice Address - Fax:308-324-3096
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE883152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055240700Medicaid
T40291Medicare UPIN
097178Medicare ID - Type Unspecified