Healthcare Provider Details

I. General information

NPI: 1700870581
Provider Name (Legal Business Name): GARRY HAAS OD, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 COUNTRY CLUB RD
SHERWOOD AR
72120-4627
US

IV. Provider business mailing address

202 COUNTRY CLUB RD
SHERWOOD AR
72120-4627
US

V. Phone/Fax

Practice location:
  • Phone: 501-835-7429
  • Fax: 501-833-0028
Mailing address:
  • Phone: 501-835-7429
  • Fax: 501-833-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2076
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: