Provider Demographics
NPI:1932180312
Name:HAEDT, MICHAEL PERRY (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PERRY
Last Name:HAEDT
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 1:303 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:MADELIA
Mailing Address - State:MN
Mailing Address - Zip Code:56062-1715
Mailing Address - Country:US
Mailing Address - Phone:573-433-1204
Mailing Address - Fax:
Practice Address - Street 1:1850 ADAMS ST STE 112
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4846
Practice Address - Country:US
Practice Address - Phone:507-387-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2994152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist