Healthcare Provider Details

I. General information

NPI: 1669448726
Provider Name (Legal Business Name): MICHAEL GAYLEN HARMON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 SHAW AVE SUITE 104
CLOVIS CA
93611-4069
US

IV. Provider business mailing address

1817 SHAW AVE SUITE 104
CLOVIS CA
93611-4069
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-3601
  • Fax: 559-298-6497
Mailing address:
  • Phone: 559-298-3601
  • Fax: 559-298-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7211T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: