Healthcare Provider Details

I. General information

NPI: 1922286319
Provider Name (Legal Business Name): GEORGE A HAAS OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 E KIEHL AVE
SHERWOOD AR
72120-3228
US

IV. Provider business mailing address

3004 E KIEHL AVE
SHERWOOD AR
72120-3228
US

V. Phone/Fax

Practice location:
  • Phone: 501-835-7800
  • Fax:
Mailing address:
  • Phone: 501-835-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2077
License Number StateAR

VIII. Authorized Official

Name: DR. GEORGE A HAAS
Title or Position: OWNER
Credential: OD
Phone: 501-835-7800