Provider Demographics
NPI:1346620432
Name:HAUCK, BRANDON STEVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:STEVEN
Last Name:HAUCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4119
Mailing Address - Country:US
Mailing Address - Phone:515-573-1145
Mailing Address - Fax:515-573-1028
Practice Address - Street 1:1428 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4119
Practice Address - Country:US
Practice Address - Phone:515-573-1145
Practice Address - Fax:515-573-1028
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0000389Medicaid
IAD02825OtherRAILROAD MEDICARE
IAD02825OtherRAILROAD MEDICARE
IAIB1233003Medicare PIN