Provider Demographics
NPI:1609047380
Name:HASELTON, DANIEL CHARLES (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CHARLES
Last Name:HASELTON
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-2014
Mailing Address - Country:US
Mailing Address - Phone:603-298-5517
Mailing Address - Fax:603-298-7898
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-2014
Practice Address - Country:US
Practice Address - Phone:603-298-5517
Practice Address - Fax:603-298-7898
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH184156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician