Timothy R Harris OD PLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

TH4901003573 Issued in MI

Legal business name

TIMOTHY R HARRIS OD PLC

Practice address

1016 S State Rd
Davison, MI 48423-1904

Phone

(810) 653-3206

Fax

(810) 653-9779

NPI assigned

Apr 20, 2007

Last updated

Feb 9, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Timothy Richard Harris, O.DNPI 1073664587

Title

Owner

Phone

(810) 653-3206

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Timothy R Harris, OD PLC

  • Optometrist
  • Davison, MI
  • NPI 1073664587

  O20100930072864

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy R Harris, OD PLC

  • Optometrist
  • Davison, MI
  • NPI 1073664587
  Medicare reassignment NPD Authorized official
• Sophia Yang, OD

  • Optometrist
  • Grosse Pointe Woods, MI
  • NPI 1629429816
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1891913414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 S STATE RD",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484231904",
            "telephone_number": "810-653-3206",
            "fax_number": "810-653-9779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 S STATE RD",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484231904",
            "telephone_number": "810-653-3206",
            "fax_number": "810-653-9779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY R HARRIS OD PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-653-3206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "TH4901003573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DURABLE MEDCAL EQUIPMENT REGIONAL CARRIER",
            "identifier": "4918860001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Davison, MI
• Providers in Davison, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.