Provider Demographics
NPI:1912978180
Name:HARRIS, BROOKS ARTHUR (OD)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:ARTHUR
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 1:192 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-1514
Mailing Address - Country:US
Mailing Address - Phone:731-635-3026
Mailing Address - Fax:731-635-0883
Practice Address - Street 1:192 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-1514
Practice Address - Country:US
Practice Address - Phone:731-635-3026
Practice Address - Fax:731-635-0883
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3595282Medicaid
TN3595828Medicare ID - Type Unspecified
TNT61270Medicare UPIN
TN0818740001Medicare NSC