Timothy R Harris, OD PLC
Individual provider Active NPI Optometrist · Davison, MI
NPI 1073664587 · NPPES record last updated Mar 28, 2011
Key facts
- NPI
- 1073664587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TH4901003573 (MI)
- Practice address
- 1016 S State Rd
Davison, MI 48423-1904 - Phone
- (810) 653-3206
- NPI assigned
- Jan 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Other NPIs on the same Medicare enrollment 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Ferris State College - College of Optometry, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1016 S State Rd
Davison, MI 48423-1904
Phone (810) 653-3206
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 25 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110512000024 | MI | Practitioner - Optometry | 5395950364 | Reassigns benefits to 1 organization |
| O20100930072864 | MI | DME Supplier - Physician - Optometrist | 2163639980 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Davison, MI |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TH4901003573 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Timothy R Harris OD PLC | Optometrist | Current |
Accepting new patients |
| Sophia K Yang, O.D, PLC | Optometrist | Current |
Accepting new patients |
Locations
1016 S State Rd
Davison, MI 48423
Phone (810) 653-3206
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TH4901003573 | MI | Yes |
Addresses
Primary practice location
1016 S State Rd
Davison, MI 48423-1904
Mailing address
1016 S State Rd
Davison, MI 48423-1904
Phone (810) 653-3206
Other providers in Davison, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.