Healthcare Provider Details

I. General information

NPI: 1972683464
Provider Name (Legal Business Name): DR. ELIZABETH HAYES HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. LISA HAYES HARVEY

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S FRANKLIN ST
FORT BRAGG CA
95437-5101
US

IV. Provider business mailing address

501 S FRANKLIN ST
FORT BRAGG CA
95437-5101
US

V. Phone/Fax

Practice location:
  • Phone: 707-964-6499
  • Fax:
Mailing address:
  • Phone: 707-964-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7736
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number7736
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number7736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: