Provider Demographics
NPI:1801875794
Name:AMERINE HARRIS, DENA (PA)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:AMERINE HARRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 ROGERS AVE STE 103A
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2068
Mailing Address - Country:US
Mailing Address - Phone:479-452-8200
Mailing Address - Fax:479-452-6779
Practice Address - Street 1:4900 ROGERS AVE STE 103A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2068
Practice Address - Country:US
Practice Address - Phone:479-452-8200
Practice Address - Fax:479-452-6779
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102252722Medicaid
ART20340Medicare UPIN
AR49771Medicare PIN