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General NPI Number Information
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NPI Number | 1902014277
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Entity Type | Organization
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Legal Business Name | KEVIN A. HARRY, O.D.
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 17125 W BLUEMOUND RD SUITE F
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City | BROOKFIELD
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State | WI
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Zip | 53005-5948
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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 | 17125 W BLUEMOUND RD SUITE F
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City | BROOKFIELD
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State | WI
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Zip | 53005-5948
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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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Authorized Official
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Title or Position | OWNER-OPTOMETRIST
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Name | KEVIN ALLEN HARRY
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Credential | OD
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Telephone | 262-786-9630
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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 | WI 2179
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License Number State | WI
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