Provider Demographics
NPI:1336249259
Name:LONNY W. HARRISON, O.D.
Entity Type:Organization
Organization Name:LONNY W. HARRISON, O.D.
Other - Org Name:ADVANCED VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-835-7474
Mailing Address - Street 1:681 MCMURRAY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1039
Mailing Address - Country:US
Mailing Address - Phone:412-835-7474
Mailing Address - Fax:412-835-1740
Practice Address - Street 1:681 MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1039
Practice Address - Country:US
Practice Address - Phone:412-835-7474
Practice Address - Fax:412-835-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0229660001Medicare NSC
PA138349Medicare ID - Type Unspecified
PAT29505Medicare UPIN