Provider Demographics
NPI:1629070875
Name:HAGGERTY, JOSEPH MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:HAGGERTY
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 1:510 ROUTE 6 AND 209
Mailing Address - Street 2:STE 6
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7615
Mailing Address - Country:US
Mailing Address - Phone:570-296-9696
Mailing Address - Fax:570-409-0316
Practice Address - Street 1:510 ROUTE 6 AND 209
Practice Address - Street 2:STE 6
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7615
Practice Address - Country:US
Practice Address - Phone:570-296-9696
Practice Address - Fax:570-409-0316
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC1T201Medicare ID - Type UnspecifiedPA MEDICARE NUMBER
PAU81549Medicare UPIN