Provider Demographics
NPI:1447292610
Name:HARRISON, KEVIN B (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:B
Last Name:HARRISON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 TOWN AND COUNTRY BLVD
Mailing Address - Street 2:SUITE 2460
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-3939
Mailing Address - Country:US
Mailing Address - Phone:713-984-9144
Mailing Address - Fax:713-461-9858
Practice Address - Street 1:700 TOWN AND COUNTRY BLVD
Practice Address - Street 2:SUITE 2460
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-3939
Practice Address - Country:US
Practice Address - Phone:713-984-9144
Practice Address - Fax:713-461-9858
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6074TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU88086Medicare UPIN
TX4554350001Medicare NSC
TX81541EMedicare PIN