=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316012107
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCHIBALD R MORRIS OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 08/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 MANOR DR
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931-2081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-472-9670
-----------------------------------------------------
Fax | 814-472-9704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 MANOR DR
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931-2081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-472-9670
-----------------------------------------------------
Fax | 814-472-9704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ARCHIBALD REGIS MORRIS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 814-472-9670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG000628
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------