Provider Demographics
NPI:1982671145
Name:HAUGE, A B
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:B
Last Name:HAUGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:HAUGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-0247
Mailing Address - Country:US
Mailing Address - Phone:605-642-4656
Mailing Address - Fax:605-722-5622
Practice Address - Street 1:1230 NORTH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3028
Practice Address - Country:US
Practice Address - Phone:605-642-4656
Practice Address - Fax:605-722-5622
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201400Medicaid
SDS2989Medicare ID - Type Unspecified
SD75125Medicare UPIN