MEDICARE: DAVID W. HARSHBERGER 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	735-OD	WV

General Provider Information

NPI Number	:	1225024235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W. HARSHBERGER O.D.

Provider Business Mailing Address
First Line	:	1142 S BRIDGE ST
Second Line	:
City	:	NEW MARTINSVILLE
State	:	WV
Zip	:	26155-1546
Country	:	US
Telephone Number	:	304-455-6268
Fax Number	:	304-455-6498

Provider Business Practice Location Address
First Line	:	1142 S BRIDGE ST
Second Line	:
City	:	NEW MARTINSVILLE
State	:	WV
Zip	:	26155-1546
Country	:	US
Telephone Number	:	304-455-6268
Fax Number	:	304-455-6498

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/08/2007

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