Healthcare Provider Details

I. General information

NPI: 1083690218
Provider Name (Legal Business Name): BRAD E HAUSER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHURCH ST W
AHOSKIE NC
27910-3316
US

IV. Provider business mailing address

500 CHURCH ST W
AHOSKIE NC
27910-3316
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-2020
  • Fax: 252-332-8543
Mailing address:
  • Phone: 252-332-2020
  • Fax: 252-332-8543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNC1332
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: