Provider Demographics
NPI:1851575021
Name:PROPHET-HARMS, KATHLEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:PROPHET-HARMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:PROPHET
Other - Last Name:HARMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:11 NEAL ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1008
Mailing Address - Country:US
Mailing Address - Phone:617-796-9949
Mailing Address - Fax:
Practice Address - Street 1:31A PROVIDENCE HWY
Practice Address - Street 2:LENSCRAFTERS
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-769-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4200152W00000X
FLOPC3662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA94814Medicare UPIN