Provider Demographics
NPI:1700876752
Name:HARRIS, MARK JASON (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JASON
Last Name:HARRIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9742 KATY FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6227
Mailing Address - Country:US
Mailing Address - Phone:713-464-3937
Mailing Address - Fax:713-464-3947
Practice Address - Street 1:9742 KATY FWY STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6227
Practice Address - Country:US
Practice Address - Phone:713-464-3937
Practice Address - Fax:713-464-3947
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4659TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0417800-01Medicaid
83020EMedicare ID - Type Unspecified