Provider Demographics
NPI:1124068788
Name:HARRISON, WILLIAM L (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:HARRISON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:111 E FOREST ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2127
Mailing Address - Country:US
Mailing Address - Phone:435-723-2144
Mailing Address - Fax:435-723-4760
Practice Address - Street 1:111 E FOREST ST
Practice Address - Street 2:SUITE E
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2127
Practice Address - Country:US
Practice Address - Phone:435-723-2144
Practice Address - Fax:435-723-4760
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112018-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870489203HA1OtherEDUCATOR'S MUTUAL
UT16700OtherPEHP
UT2116865206 2OtherBENESYS
UT37044OtherDESERET MUTUAL
UT1424777OtherMAILHANDLERS
ID320341OtherBLUE SHIELD OF IDAHO
UTQM0000030898OtherALTIUS
UT107009215103OtherIHC
UT557942OtherFOCUS
UT73288OtherCCN
UT16700OtherPEHP
UT2116865206 2OtherBENESYS
UT000009535Medicare ID - Type Unspecified
UT0447530001Medicare NSC