Healthcare Provider Details

I. General information

NPI: 1861490930
Provider Name (Legal Business Name): JEAN RENEE HAUSHEER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W GORE BLVD SUITE 200
LAWTON OK
73505-6378
US

IV. Provider business mailing address

608 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5014
US

V. Phone/Fax

Practice location:
  • Phone: 580-250-5855
  • Fax: 580-250-5808
Mailing address:
  • Phone: 405-271-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR8E77
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04-26265
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number28850
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: