MEDICARE: ELLENER HARPER OD

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	10032TG	TX

General Provider Information

NPI Number	:	1942828371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLENER HARPER OD

Provider Business Mailing Address
First Line	:	9232 OLDWEST TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-3114
Country	:	US
Telephone Number	:	757-334-2957
Fax Number	:

Provider Business Practice Location Address
First Line	:	1449 AVONDALE HASLET RD
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-3510
Country	:	US
Telephone Number	:	817-439-5400
Fax Number	:

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	06/28/2024

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