MEDICARE: DR. SUSAN MARIE HAAS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TO3474	MO

General Provider Information

NPI Number	:	1417060153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MARIE HAAS O.D.

Provider Business Mailing Address
First Line	:	1816 S MICHIGAN AVE
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64804-0948
Country	:	US
Telephone Number	:	417-781-3027
Fax Number	:

Provider Business Practice Location Address
First Line	:	2623 WEST 7TH STREET
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64801
Country	:	US
Telephone Number	:	417-206-4880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/09/2007

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