Healthcare Provider Details

I. General information

NPI: 1861909988
Provider Name (Legal Business Name): HARRIS FAMILY EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 HARRIS AVE NE STE 1
PALM BAY FL
32905-4044
US

IV. Provider business mailing address

11304 SW BARTON WAY
PORT SAINT LUCIE FL
34987-2789
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-2020
  • Fax: 321-724-9088
Mailing address:
  • Phone: 908-304-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5202
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC5202
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPC5202
License Number StateFL

VIII. Authorized Official

Name: BRIAN HARRIS
Title or Position: CEO/OD
Credential: OD
Phone: 321-724-2020