Provider Demographics
NPI:1912178625
Name:HARBIN, LARRY EUGENE (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:EUGENE
Last Name:HARBIN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4016
Mailing Address - Country:US
Mailing Address - Phone:336-768-8854
Mailing Address - Fax:336-765-7453
Practice Address - Street 1:1714 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4016
Practice Address - Country:US
Practice Address - Phone:336-768-8854
Practice Address - Fax:336-765-7453
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC601156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician