Provider Demographics
NPI:1124071352
Name:HARKINS, DENNIS E (OD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:E
Last Name:HARKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851B NEW PINERY RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-9257
Mailing Address - Country:US
Mailing Address - Phone:608-742-5522
Mailing Address - Fax:608-745-5454
Practice Address - Street 1:2851B NEW PINERY RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9257
Practice Address - Country:US
Practice Address - Phone:608-742-5522
Practice Address - Fax:608-745-5454
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1625-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124071352Medicaid
WI1124071352Medicaid
WI410041208Medicare PIN
WI803OtherDEAN HEALTH INSURANCE
WI1006612OtherPHYSICIANS PLUS
WI000447810Medicare PIN