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General NPI Number Information
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NPI Number | 1821078189
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Entity Type | Individual
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Provider Name | KEVIN A HARRY OD
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Gender | Male
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 15300 WATERTOWN PLANK RD
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City | ELM GROVE
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State | WI
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Zip | 53122-2300
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Country | US
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Telephone | 262-786-9630
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Fax | 262-786-3972
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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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 | 2179
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License Number State | WI
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