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General NPI Number Information
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NPI Number | 1265663769
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Entity Type | Organization
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Legal Business Name | RONALD LEE HARRIS
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 6040 COMMERCE BLVD STE. 109
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2181
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Country | US
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Telephone | 707-585-2020
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Fax | 707-585-2563
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Provider Business Mailing Address
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Address Line | 6040 COMMERCE BLVD STE. 109
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2181
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Country | US
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Telephone | 707-585-2020
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Fax | 707-585-2563
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Authorized Official
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Title or Position | OWNNER
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Name | DR. RONALD L. HARRIS
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Credential | O.D.
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Telephone | 707-585-2020
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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 | 04916T
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License Number State | CA
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