Provider Demographics
NPI:1144298092
Name:HARRELL, JEFFREY T (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:HARRELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1124 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3469
Mailing Address - Country:US
Mailing Address - Phone:972-221-2563
Mailing Address - Fax:972-219-1324
Practice Address - Street 1:1124 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3469
Practice Address - Country:US
Practice Address - Phone:972-221-2563
Practice Address - Fax:972-219-1324
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3945TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist