1649449679 NPI number — GARRY HAAS EYE CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649449679 NPI number — GARRY HAAS EYE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARRY HAAS EYE CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAAS BRIGHT EYE CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649449679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 COUNTRY CLUB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERWOOD
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72120-4627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-835-7429
Provider Business Mailing Address Fax Number:
501-833-0028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERWOOD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72120-4627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-835-7429
Provider Business Practice Location Address Fax Number:
501-833-0028
Provider Enumeration Date:
02/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
MICHELE
Authorized Official Title or Position:
MEDICAL BILLING MNGR
Authorized Official Telephone Number:
501-835-7429

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2076 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 47966 . This is a "FEDERAL BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 0158840002 . This is a "CIGNA GOVT SERVICES" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 47966 . This is a "ARBCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 47966 . This is a "ARKANSAS MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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