Provider Demographics
NPI:1023063781
Name:HARRISON, HOWARD S (OD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:S
Last Name:HARRISON
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 1:33 BROAD ST
Mailing Address - Street 2:LOBBY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4216
Mailing Address - Country:US
Mailing Address - Phone:617-742-7200
Mailing Address - Fax:617-742-7272
Practice Address - Street 1:33 BROAD ST
Practice Address - Street 2:LOBBY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4216
Practice Address - Country:US
Practice Address - Phone:617-742-7200
Practice Address - Fax:617-742-7272
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2352TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0313351Medicaid
MA142658Medicare ID - Type Unspecified
T59193Medicare UPIN