MEDICARE: LAURA L HARRIS MD

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	207W00000X	Ophthalmology Physician	98-00891	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1096Q	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972501260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L HARRIS MD

Provider Business Mailing Address
First Line	:	1135 MILITARY CUTOFF RD
Second Line	:	SUITE 201
City	:	WILMINGTON
State	:	NC
Zip	:	28405-3966
Country	:	US
Telephone Number	:	910-256-4899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 MILITARY CUTOFF RD
Second Line	:	SUITE 201
City	:	WILMINGTON
State	:	NC
Zip	:	28405-3966
Country	:	US
Telephone Number	:	910-256-4899
Fax Number	:

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/31/2012

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