Provider Demographics
NPI:1982696498
Name:HARRISON, MICHELLE MORRIS (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MORRIS
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:111 E 4TH ST STE 440
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6241
Mailing Address - Country:US
Mailing Address - Phone:618-462-9818
Mailing Address - Fax:314-741-4947
Practice Address - Street 1:264 HIGHWAY 641 N
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1329
Practice Address - Country:US
Practice Address - Phone:731-584-7942
Practice Address - Fax:731-584-7965
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001677152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5848609OtherAETNA
TN004006095OtherTENNCARE SELECT
TN200721045001OtherTRICARE
TN3723849Medicaid
TN4266337OtherCIGNA
TNP00193746OtherRAILROAD MEDICARE
TN004006095OtherANTHEM BLUE CROSS BLUE SH
TN004006095OtherBLUE CROSS BLUE SHIELD
TN200721045OtherOMNICARE
TN200721045OtherHEALTH PARTNERS
TN200721045OtherBOILERMAKERS
TN004006095OtherBLUE CROSS BLUE SHIELD
TN200721045001OtherTRICARE