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General NPI Number Information
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NPI Number | 1104826387
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Entity Type | Individual
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Provider Name | KIRK RANDALL HARRIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 1302 BROWN ST
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City | WASHINGTON
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State | NC
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Zip | 27889-4672
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Country | US
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Telephone | 252-946-7257
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Fax | 252-946-9497
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Provider Business Mailing Address
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Address Line | 1950 OLD GALLOWS RD
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City | VIENNA
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State | VA
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Zip | 22182-3990
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Country | US
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Telephone | 703-847-8899
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Fax | 703-991-0514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1419
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License Number State | NC
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