Provider Demographics
NPI:1164861860
Name:HAACK, LAUREN RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:RENEE
Last Name:HAACK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:RENEE
Other - Last Name:CONQUEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6224 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7008
Mailing Address - Country:US
Mailing Address - Phone:937-310-7138
Mailing Address - Fax:937-310-7145
Practice Address - Street 1:6224 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-7008
Practice Address - Country:US
Practice Address - Phone:937-310-7138
Practice Address - Fax:937-310-7145
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist