Basic Information
| Provider Information | |||||||||
| NPI: | 1639112162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARROLD | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | BLAIR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2325 SUNSET AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524515300 | ||||||||
| FaxNumber: | 2524515330 | ||||||||
| Practice Location | |||||||||
| Address1: | 819 TIFFANY BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278041812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529722020 | ||||||||
| FaxNumber: | 2529777241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0854 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 09364 | 01 | NC | BCBSNC INDIVIDUAL NUMBER | OTHER |