MEDICARE: DONALD E HAIDERER O.D.

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	4901003099	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447356860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD E HAIDERER O.D.

Provider Business Mailing Address
First Line	:	5416 MICHAEL RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-3004
Country	:	US
Telephone Number	:	989-684-9203
Fax Number	:

Provider Business Practice Location Address
First Line	:	5416 MICHAEL RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-3004
Country	:	US
Telephone Number	:	989-684-9203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/09/2007

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