Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 967S | OH |
NPI | 1215058961 |
---|---|
Provider Name | Mr. Jeffrey Alan Harris |
First Address | Baltimore, OH 43105-1004 |
Second Address | Baltimore, OH 43105-1004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0603421 | (05) | OH |