Provider Demographics
NPI:1649251695
Name:MICHAEL K HASKETT OD PC
Entity type:Organization
Organization Name:MICHAEL K HASKETT OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:HASKETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-372-2701
Mailing Address - Street 1:141 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHASE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23924-1609
Mailing Address - Country:US
Mailing Address - Phone:434-372-2701
Mailing Address - Fax:434-372-3355
Practice Address - Street 1:141 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHASE CITY
Practice Address - State:VA
Practice Address - Zip Code:23924-1609
Practice Address - Country:US
Practice Address - Phone:434-372-2701
Practice Address - Fax:434-372-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA063596OtherBCBS
VA410038621OtherRAILROAD MEDICARE
VA009206019Medicaid
VA0180770001Medicare NSC
VAC10617Medicare PIN
VA063596OtherBCBS