Healthcare Provider Details

I. General information

NPI: 1851152755
Provider Name (Legal Business Name): WILLIAM HARRISON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BLOWING ROCK RD STE A1
BOONE NC
28607-4600
US

IV. Provider business mailing address

133 SNOW PLOW RD
BANNER ELK NC
28604
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2783
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: