1790014900 NPI number — ADVANCED GLAUCOMA SPECIALISTS

Table of content: DR. DAVID E. HARRIS DO (NPI 1154588416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790014900 NPI number — ADVANCED GLAUCOMA SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED GLAUCOMA SPECIALISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1790014900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PONDMEADOW DR
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01867-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-942-9876
Provider Business Mailing Address Fax Number:
781-942-9877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 PONDMEADOW DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01867-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-942-9876
Provider Business Practice Location Address Fax Number:
781-942-9877
Provider Enumeration Date:
12/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LATINA
Authorized Official First Name:
MARK
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
781-942-9876

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  48630 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 977865 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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