Provider Demographics
NPI:1295287894
Name:EDWARD HAACK OD INC
Entity type:Organization
Organization Name:EDWARD HAACK OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:415-891-9090
Mailing Address - Street 1:1102 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1054
Mailing Address - Country:US
Mailing Address - Phone:415-891-9090
Mailing Address - Fax:415-891-9080
Practice Address - Street 1:1102 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1054
Practice Address - Country:US
Practice Address - Phone:415-891-9090
Practice Address - Fax:415-891-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-29
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty