Individual
JEDIAH WILLIAM HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
843 W STUART DR STE 7, HILLSVILLE, VA 24343-1555
(276) 728-9323
Mailing address
843 W STUART DR STE 7, HILLSVILLE, VA 24343-1555
(276) 728-9323
(276) 728-0400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618002783
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0618002783
LICENSE
VA
01
—
1063704435
GROUP NPI
—
01
—
1962068379
NATIONAL PROVIDER NUMBER
VA
Enumeration date
05/13/2019
Last updated
07/24/2019
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