Healthcare Provider Details

I. General information

NPI: 1659721280
Provider Name (Legal Business Name): BROOKE MORRIS HARKNESS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE KATHLEEN MORRIS

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15298 SW ROYALTY PKWY
TIGARD OR
97224-3904
US

IV. Provider business mailing address

3303 SW BOND AVE MAIL CODE CH11P
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-2020
  • Fax: 503-598-9661
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3663ATI
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: