Provider Demographics
NPI:1649249442
Name:HARRIS, KIMBERLY KAY (OD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:319 YORK RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3160
Practice Address - Country:US
Practice Address - Phone:717-258-4422
Practice Address - Fax:717-258-4245
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1681247OtherCLARITY VISION
VI1631464OtherCLARITY VISION
PA97915OtherVISION BENEFITS OF AMERIC
01704701OtherCAPITAL BLUE CROSS
52796OtherDAVIS VISION
397407OtherNATIONAL VISION ADMIN
397245OtherNATIONAL VISION ADMIN
PA7915OtherVISON BENEFITS OF AMERICA
PAVI1681247OtherPA BLUE SHIELD
397245OtherNATIONAL VISION ADMIN
PAVI1681247OtherPA BLUE SHIELD