Provider Demographics
NPI:1861490930
Name:HAUSHEER, JEAN RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:RENEE
Last Name:HAUSHEER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 STANTON L YOUNG BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5014
Mailing Address - Country:US
Mailing Address - Phone:405-271-6060
Mailing Address - Fax:
Practice Address - Street 1:3201 W GORE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6378
Practice Address - Country:US
Practice Address - Phone:580-250-5855
Practice Address - Fax:580-250-5808
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8E77207W00000X
KS04-26265207W00000X
OK28850207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200402750AMedicaid
KS4055505EMedicare PIN
MO4055505HMedicare PIN
KS180033712Medicare PIN
MO4055505DMedicare PIN
C50491Medicare UPIN
OK200402750AMedicaid
MOP00138483Medicare PIN