Provider Demographics
NPI:1669463923
Name:HAGGE, HAL E (OD)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:E
Last Name:HAGGE
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 1:10928 EAGLE RIVER RD
Mailing Address - Street 2:STE.# 102
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8038
Mailing Address - Country:US
Mailing Address - Phone:907-694-2020
Mailing Address - Fax:907-694-5989
Practice Address - Street 1:10928 EAGLE RIVER RD
Practice Address - Street 2:STE.# 102
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8038
Practice Address - Country:US
Practice Address - Phone:907-694-2020
Practice Address - Fax:907-694-5989
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK95152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK95OtherOPTOMETRY LICENSE
AKOP0095Medicaid
AKOP0095Medicaid
AK0000PHFVTMedicare ID - Type Unspecified
AK95OtherOPTOMETRY LICENSE