Provider Demographics
NPI:1376651067
Name:HARANO & HAW OPTOMETRIC CORP
Entity Type:Organization
Organization Name:HARANO & HAW OPTOMETRIC CORP
Other - Org Name:ESTUDILLO PLAZA OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-586-0320
Mailing Address - Street 1:1377 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3918
Mailing Address - Country:US
Mailing Address - Phone:510-357-2020
Mailing Address - Fax:510-357-2086
Practice Address - Street 1:1377 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-3918
Practice Address - Country:US
Practice Address - Phone:510-357-2020
Practice Address - Fax:510-357-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058712Medicaid
CAZZZ25074ZMedicare ID - Type Unspecified