Provider Demographics
NPI:1972683191
Name:HARVER, EDWARD K (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:K
Last Name:HARVER
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 1:4502 BONITA RD
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1427
Mailing Address - Country:US
Mailing Address - Phone:619-479-7334
Mailing Address - Fax:619-475-3456
Practice Address - Street 1:4502 BONITA RD
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1427
Practice Address - Country:US
Practice Address - Phone:619-479-7334
Practice Address - Fax:619-475-3456
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 5688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD 0056880Medicaid
CA0288200001Medicare NSC
CAOP5688Medicare PIN
CASD 0056880Medicaid