MEDICARE: DR. JONATHAN GUY HARP 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	S-886-TA-479	AL

General Provider Information

NPI Number	:	1467559088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN GUY HARP O.D.

Provider Business Mailing Address
First Line	:	1809 BRITTON DR
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36870-3447
Country	:	US
Telephone Number	:	706-570-3301
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 HIGHWAY 431 N
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-2362
Country	:	US
Telephone Number	:	334-291-6379
Fax Number	:	334-291-9109

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	07/08/2007

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