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General NPI Number Information
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NPI Number | 1497851414
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Entity Type | Individual
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Provider Name | TODD LINCOLN HARRIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 555 E GENESEE ST
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City | LAPEER
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State | MI
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Zip | 48446-4611
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Country | US
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Telephone | 810-245-3653
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Fax |
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Provider Business Mailing Address
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Address Line | C/O BANK OF AMERICA P.O. BOX 60982
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City | SAINT LOUIS
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State | MO
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Zip | 63160-0001
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Country | US
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Telephone | 810-793-1411
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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 | 4901003144
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License Number State | MI
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