Provider Demographics
NPI:1801885736
Name:HAW, EDDY L (OD)
Entity type:Individual
Prefix:DR
First Name:EDDY
Middle Name:L
Last Name:HAW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3918
Mailing Address - Country:US
Mailing Address - Phone:510-357-2020
Mailing Address - Fax:510-357-2086
Practice Address - Street 1:1377 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-3918
Practice Address - Country:US
Practice Address - Phone:510-357-2020
Practice Address - Fax:510-357-2086
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5871152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058712Medicaid
CAT10150Medicare UPIN
CAZZZ25074ZMedicare ID - Type Unspecified