Healthcare Provider Details

I. General information

NPI: 1447257266
Provider Name (Legal Business Name): DEVIN A HARRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BRADLEY BLVD.
RICHLAND WA
99352-4419
US

IV. Provider business mailing address

PO BOX 1529
RICHLAND WA
99352-1529
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-2240
  • Fax: 509-943-1575
Mailing address:
  • Phone: 509-943-2240
  • Fax: 509-943-1575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00031796
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number00031796
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00031796
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: