Provider Demographics
NPI:1801076542
Name:JD HARRIS PC
Entity type:Organization
Organization Name:JD HARRIS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY/BUSINESS MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:ERNESTINA
Authorized Official - Last Name:OLIVIERI-HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-526-9697
Mailing Address - Street 1:11020 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3007
Mailing Address - Country:US
Mailing Address - Phone:503-526-9697
Mailing Address - Fax:503-644-8330
Practice Address - Street 1:11020 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3007
Practice Address - Country:US
Practice Address - Phone:503-789-6720
Practice Address - Fax:503-644-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
OR1863T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500614131Medicaid
ORR153399Medicare PIN
ORR153400Medicare PIN