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General NPI Number Information
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NPI Number | 1366651606
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Entity Type | Organization
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Legal Business Name | TERRY J HARRISON OD PC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 1230 SOUTH BROADWAY
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City | POTEAU
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State | OK
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Zip | 74953-0490
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Country | US
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Telephone | 918-647-2153
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Fax | 918-647-8711
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Provider Business Mailing Address
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Address Line | PO BOX 490
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City | POTEAU
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State | OK
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Zip | 74953-0490
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Country | US
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Telephone | 918-647-2153
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Fax | 918-647-8711
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. TERRY J HARRISON
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Credential | OD
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Telephone | 918-647-2153
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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 | 859
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License Number State | OK
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