Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2847 | FL |
NPI | 1013018043 |
---|---|
Provider Name | Dr. Rusk Harris |
First Address | Davie, FL 33324-4415 |
Second Address | Davie, FL 33324-4415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51266 | (02) | FL |
62009230 | (05) | FL |