Provider Demographics
NPI:1982375556
Name:HASKEW, AUSTIN (OP)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:HASKEW
Suffix:
Gender:M
Credentials:OP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 MARIE DR
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-1711
Mailing Address - Country:US
Mailing Address - Phone:205-644-0473
Mailing Address - Fax:
Practice Address - Street 1:1108 MARIE DR
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-1711
Practice Address - Country:US
Practice Address - Phone:205-644-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT-27136156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician