Provider Demographics
NPI:1700870581
Name:HAAS, GARRY (OD, PA)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:HAAS
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4627
Mailing Address - Country:US
Mailing Address - Phone:501-835-7429
Mailing Address - Fax:501-833-0028
Practice Address - Street 1:202 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-4627
Practice Address - Country:US
Practice Address - Phone:501-835-7429
Practice Address - Fax:501-833-0028
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2076152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR000001129508OtherWINDSOR MEDICARE
AR106676722Medicaid
AR410014315OtherRAILROAD MEDICARE
AR47966OtherBLUE CROSS BLUE SHEILD
AR106676722Medicaid
AR0158840002Medicare NSC
AR47966OtherBLUE CROSS BLUE SHEILD