Healthcare Provider Details

I. General information

NPI: 1831547157
Provider Name (Legal Business Name): BRIAN HARRIS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
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

2186 HARRIS AVE NE
PALM BAY FL
32905-4044
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: