Provider Demographics
NPI:1255761839
Name:HARBECK, KERRY
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:HARBECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-3231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 KENWOOD AVE
Practice Address - Street 2:411 KENWOOD AVE.
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-3231
Practice Address - Country:US
Practice Address - Phone:518-439-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY3818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist