Provider Demographics
NPI:1205987534
Name:HARRITY, JAMES G (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:HARRITY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9689
Mailing Address - Country:US
Mailing Address - Phone:716-947-9992
Mailing Address - Fax:716-947-9082
Practice Address - Street 1:6913 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9689
Practice Address - Country:US
Practice Address - Phone:716-947-9992
Practice Address - Fax:716-947-9082
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3089156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0633690001Medicare NSC
NYAA0376Medicare ID - Type UnspecifiedPROVIDER # MEDICARE PART