MEDICARE: EDWARD HAACK OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1295287894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD HAACK OD INC

Provider Business Mailing Address
First Line	:	1102 MAGNOLIA AVE
Second Line	:
City	:	LARKSPUR
State	:	CA
Zip	:	94939-1054
Country	:	US
Telephone Number	:	415-891-9090
Fax Number	:	415-891-9080

Provider Business Practice Location Address
First Line	:	1102 MAGNOLIA AVE
Second Line	:
City	:	LARKSPUR
State	:	CA
Zip	:	94939-1054
Country	:	US
Telephone Number	:	415-891-9090
Fax Number	:	415-891-9080

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD HAACK
Credential	:	O.D.
Telephone Number	:	415-891-9090

Provider Enumeration Date	:	10/29/2016
Last Update Date	:	03/28/2017

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Directions to “EDWARD HAACK OD INC ” Practice Location

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