MEDICARE: RONALD L. HARRIS, OD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	900	CO

General Provider Information

NPI Number	:	1063685519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD L. HARRIS, OD, PC

Provider Business Mailing Address
First Line	:	6675 BUSINESS CENTER DR
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80130-3603
Country	:	US
Telephone Number	:	303-683-8165
Fax Number	:

Provider Business Practice Location Address
First Line	:	6675 BUSINESS CENTER DR
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80130-3603
Country	:	US
Telephone Number	:	303-683-8165
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	RONALD L HARRIS
Credential	:	OD
Telephone Number	:	303-683-8165

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	04/04/2008

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