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General NPI Number Information
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NPI Number | 1194863183
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Entity Type | Individual
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Provider Name | KEVIN RUSSELL HARRIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2620 CENTRON DR SW
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City | DECATUR
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State | AL
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Zip | 35603-2500
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Country | US
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Telephone | 256-350-6655
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Fax | 256-350-2548
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Provider Business Mailing Address
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Address Line | 1641 BYRD RD
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City | HARTSELLE
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State | AL
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Zip | 35640-5907
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Country | US
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Telephone | 256-751-1125
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Fax |
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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 | S813 TA107
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License Number State | AL
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