Provider Demographics
NPI:1205803582
Name:MORRILL, HAROLD EUGENE (OD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:EUGENE
Last Name:MORRILL
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-0247
Mailing Address - Country:US
Mailing Address - Phone:865-475-8680
Mailing Address - Fax:865-475-8681
Practice Address - Street 1:741 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4907
Practice Address - Country:US
Practice Address - Phone:865-475-8680
Practice Address - Fax:865-475-8681
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3594104Medicare ID - Type Unspecified
TNT61172Medicare UPIN