Provider Demographics
NPI:1972683464
Name:HARVEY, ELIZABETH HAYES
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HAYES
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:HAYES
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:501 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5101
Mailing Address - Country:US
Mailing Address - Phone:707-964-6499
Mailing Address - Fax:
Practice Address - Street 1:501 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5101
Practice Address - Country:US
Practice Address - Phone:707-964-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7736152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy