Provider Demographics
NPI:1548740772
Name:HAUGEN, TREY MICHEL (OD)
Entity Type:Individual
Prefix:DR
First Name:TREY
Middle Name:MICHEL
Last Name:HAUGEN
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 1:1226 SAINT PAUL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2744
Mailing Address - Country:US
Mailing Address - Phone:320-905-3439
Mailing Address - Fax:
Practice Address - Street 1:6020 MEADOWRIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6528
Practice Address - Country:US
Practice Address - Phone:410-872-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDTA2653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program