Provider Demographics
NPI:1841842275
Name:HADEN, DEREK (OD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:HADEN
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 1:1115 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-2843
Mailing Address - Country:US
Mailing Address - Phone:067-335-5139
Mailing Address - Fax:
Practice Address - Street 1:1115 S ELM ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-2843
Practice Address - Country:US
Practice Address - Phone:706-335-5139
Practice Address - Fax:706-335-9363
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E21152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist