=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134351802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIAN D. HAAS M.D. P.L.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2009
-----------------------------------------------------
Last Update Date | 11/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 BRIERCLIFF DRIVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-841-1490
-----------------------------------------------------
Fax | 407-841-6464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 BRIERCLIFF DRIVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-841-1490
-----------------------------------------------------
Fax | 407-841-6464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DORIS BLAKEMORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-841-1490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME 0069320
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------