Provider Demographics
NPI:1366520140
Name:HARRISON, CAMILLE M (MD)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:M
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:72301 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-8007
Mailing Address - Country:US
Mailing Address - Phone:760-895-1993
Mailing Address - Fax:760-862-1992
Practice Address - Street 1:72301 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 108
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-8007
Practice Address - Country:US
Practice Address - Phone:760-895-1993
Practice Address - Fax:760-862-1992
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A649000Medicaid
00A649000Medicare ID - Type Unspecified
G29689Medicare UPIN