Provider Demographics
NPI:1760574784
Name:HARRIS, JOHN DOUGHERTY (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGHERTY
Last Name:HARRIS
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 1:226 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-9701
Mailing Address - Country:US
Mailing Address - Phone:413-949-3255
Mailing Address - Fax:
Practice Address - Street 1:226 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-9701
Practice Address - Country:US
Practice Address - Phone:413-533-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2180152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2180OtherLICENSE