Provider Demographics
NPI:1770163305
Name:SQUARE EYECARE, PLLC.
Entity type:Organization
Organization Name:SQUARE EYECARE, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HABA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-603-5124
Mailing Address - Street 1:50 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2605
Mailing Address - Country:US
Mailing Address - Phone:901-603-5124
Mailing Address - Fax:901-751-2399
Practice Address - Street 1:50 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2605
Practice Address - Country:US
Practice Address - Phone:901-603-5124
Practice Address - Fax:901-751-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty