Provider Demographics
NPI:1174594006
Name:HARRIS, MARK S (OD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:IN
Mailing Address - Zip Code:46910-0640
Mailing Address - Country:US
Mailing Address - Phone:574-893-7050
Mailing Address - Fax:574-893-7540
Practice Address - Street 1:100 W ROCHESTER ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:IN
Practice Address - Zip Code:46910-9997
Practice Address - Country:US
Practice Address - Phone:574-893-7050
Practice Address - Fax:574-893-7540
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist