Healthcare Provider Details

I. General information

NPI: 1801076542
Provider Name (Legal Business Name): JD HARRIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 SW BEAVERTON HILLSDALE HWY
BEAVERTON OR
97005-3007
US

IV. Provider business mailing address

11020 SW BEAVERTON HILLSDALE HWY
BEAVERTON OR
97005-3007
US

V. Phone/Fax

Practice location:
  • Phone: 503-789-6720
  • Fax: 503-644-8330
Mailing address:
  • Phone: 503-526-9697
  • Fax: 503-644-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1863T
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: IRENE ERNESTINA OLIVIERI-HARRIS
Title or Position: CORPORATE SECRETARY/BUSINESS MANAGE
Credential:
Phone: 503-526-9697