Provider Demographics
NPI:1457589798
Name:HARN-REID, NATALIE WADE (OD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:WADE
Last Name:HARN-REID
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NATALIE
Other - Middle Name:WADE
Other - Last Name:HARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:18628 TOWN HARBOUR ROAD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031
Mailing Address - Country:US
Mailing Address - Phone:704-987-1146
Mailing Address - Fax:
Practice Address - Street 1:1480 CONCORD PARKWAY
Practice Address - Street 2:CAROLINA MALL #301
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-721-5530
Practice Address - Fax:704-786-0310
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U05221Medicare UPIN