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General NPI Number Information
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NPI Number | 1295287894
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Entity Type | Organization
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Legal Business Name | EDWARD HAACK OD INC
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Dates
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Enumeration Date | 10/29/2016
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 1102 MAGNOLIA AVE
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City | LARKSPUR
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State | CA
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Zip | 94939-1054
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Country | US
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Telephone | 415-891-9090
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Fax | 415-891-9080
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Provider Business Mailing Address
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Address Line | 1102 MAGNOLIA AVE
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City | LARKSPUR
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State | CA
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Zip | 94939-1054
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Country | US
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Telephone | 415-891-9090
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Fax | 415-891-9080
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD HAACK
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Credential | O.D.
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Telephone | 415-891-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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