Provider Demographics
NPI:1912002833
Name:HARVEY, JUDITH ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ELLEN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:ELLEN
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1913 E SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2532
Mailing Address - Country:US
Mailing Address - Phone:417-889-7337
Mailing Address - Fax:417-889-7337
Practice Address - Street 1:1913 E SEMINOLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2532
Practice Address - Country:US
Practice Address - Phone:417-889-7337
Practice Address - Fax:417-889-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5A38207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10961Medicare UPIN