Healthcare Provider Details

I. General information

NPI: 1649237223
Provider Name (Legal Business Name): ALLISON HATLEY HARRIS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA ALLISON HATLEY

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 BROWN ST
WASHINGTON NC
27889-4672
US

IV. Provider business mailing address

1950 OLD GALLOWS RD SUITE 520
VIENNA VA
22182-3990
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-7257
  • Fax:
Mailing address:
  • Phone: 703-847-8899
  • Fax: 703-991-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1389
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: