Provider Demographics
NPI:1821005174
Name:HAAS, DANIEL J (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:HAAS
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 1:42 DEER TRACK RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4764
Mailing Address - Country:US
Mailing Address - Phone:864-458-9466
Mailing Address - Fax:
Practice Address - Street 1:1137 WOODRUFF RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4115
Practice Address - Country:US
Practice Address - Phone:864-438-2079
Practice Address - Fax:864-234-4643
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA01068103Medicare PIN
T47953Medicare UPIN