MEDICARE: DR. HAROLD EUGENE MORRILL O.D.

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	586	TN

General Provider Information

NPI Number	:	1205803582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD EUGENE MORRILL O.D.

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-0247
Country	:	US
Telephone Number	:	865-475-8680
Fax Number	:	865-475-8681

Provider Business Practice Location Address
First Line	:	741 E BROADWAY BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-4907
Country	:	US
Telephone Number	:	865-475-8680
Fax Number	:	865-475-8681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2006
Last Update Date	:	03/27/2008

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