Provider Demographics
NPI:1912911645
Name:HARRIS, BARRY (OD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4854
Mailing Address - Country:US
Mailing Address - Phone:870-239-2251
Mailing Address - Fax:870-239-6017
Practice Address - Street 1:901 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4854
Practice Address - Country:US
Practice Address - Phone:870-239-2251
Practice Address - Fax:870-239-6017
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR496207933OtherMEDICARE ID-UNSPECIFIED
ARP00146489OtherRAILROAD MEDICARE
AR102580722Medicaid
AR496207933OtherMEDICARE ID-UNSPECIFIED
AR49620Medicare PIN