Provider Demographics
NPI:1417942665
Name:HAUSWIRTH, SCOTT G (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:HAUSWIRTH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9801 DUPONT AVE S
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3100
Mailing Address - Country:US
Mailing Address - Phone:952-567-6092
Mailing Address - Fax:952-567-6176
Practice Address - Street 1:9801 DUPONT AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3100
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:952-884-2656
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2738152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN023698500Medicaid
MN023698500Medicaid
U82303Medicare UPIN