1124068788 NPI number — DR. WILLIAM L HARRISON O.D.

Table of content: DR. WILLIAM L HARRISON O.D. (NPI 1124068788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124068788 NPI number — DR. WILLIAM L HARRISON O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
WILLIAM
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124068788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E FOREST ST
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
BRIGHAM CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84302-2127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-723-2144
Provider Business Mailing Address Fax Number:
435-723-4760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E FOREST ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
BRIGHAM CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84302-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-723-2144
Provider Business Practice Location Address Fax Number:
435-723-4760
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  112018-9934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 870489203HA1 . This is a "EDUCATOR'S MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 16700 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 2116865206 2 . This is a "BENESYS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 37044 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1424777 . This is a "MAILHANDLERS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 320341 . This is a "BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000030898 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107009215103 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 557942 . This is a "FOCUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 73288 . This is a "CCN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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