MEDICARE: DR. MICHELLE MORRIS HARRISON 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	OD0000001677	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00193746	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5848609	OTHER	TN	AETNA
2	004006095	OTHER	TN	TENNCARE SELECT
3	200721045001	OTHER	TN	TRICARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4266337	OTHER	TN	CIGNA
7	004006095	OTHER	TN	ANTHEM BLUE CROSS BLUE SH
8	004006095	OTHER	TN	BLUE CROSS BLUE SHIELD
9	200721045	OTHER	TN	OMNICARE
10	200721045	OTHER	TN	HEALTH PARTNERS
11	200721045	OTHER	TN	BOILERMAKERS

General Provider Information

NPI Number	:	1982696498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE MORRIS HARRISON OD

Provider Business Mailing Address
First Line	:	111 E 4TH ST STE 440
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6241
Country	:	US
Telephone Number	:	618-462-9818
Fax Number	:	314-741-4947

Provider Business Practice Location Address
First Line	:	264 HIGHWAY 641 N
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-1329
Country	:	US
Telephone Number	:	731-584-7942
Fax Number	:	731-584-7965

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	10/05/2022

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