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NPI Code Detail

MEDICARE: DR. ROGER B HAAG O.D.

MEDICARE: DR. ROGER B HAAG 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
1152W00000XOptometrist4901002500MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10421320001OTHERMIMED-B-DME
2813459OTHERMIEYEMED VISION CARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4900F367430OTHERMIBLUE CROSS BLUE SHIELD
5VC630013OTHERMIM-CARE VISION

General Provider Information

NPI Number : 1659439610
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER B HAAG O.D.
Provider Business Mailing Address
First Line : 107 N LAFAYETTE ST
Second Line :
City : SOUTH LYON
State : MI
Zip : 48178-1210
Country : US
Telephone Number : 248-437-2002
Fax Number : 248-437-6838
Provider Business Practice Location Address
First Line : 107 N LAFAYETTE ST
Second Line :
City : SOUTH LYON
State : MI
Zip : 48178-1210
Country : US
Telephone Number : 248-437-2002
Fax Number : 248-437-6838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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