Provider Demographics
NPI:1821401951
Name:HARRIS, ALISHA (OD)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:HARRIS
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 1:1371 HECLA DR STE C1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2318
Mailing Address - Country:US
Mailing Address - Phone:303-957-3072
Mailing Address - Fax:303-957-3073
Practice Address - Street 1:1371 HECLA DR STE C1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2318
Practice Address - Country:US
Practice Address - Phone:303-957-3072
Practice Address - Fax:303-957-3073
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPP0003047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71438572Medicaid