Provider Demographics
NPI:1821091877
Name:HASKELL, SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:HASKELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BELKNAP ST
Mailing Address - Street 2:STE 1
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3643
Mailing Address - Country:US
Mailing Address - Phone:603-742-5719
Mailing Address - Fax:603-743-5811
Practice Address - Street 1:155 BORTHWICK AVE
Practice Address - Street 2:SUITE 200 EAST
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7156
Practice Address - Country:US
Practice Address - Phone:603-436-1773
Practice Address - Fax:603-427-0655
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000066Medicaid
NH80000066Medicaid
T88156Medicare UPIN