Provider Demographics
NPI:1174720544
Name:DANIEL J HAAS, LLC
Entity type:Organization
Organization Name:DANIEL J HAAS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-438-2079
Mailing Address - Street 1:1137 WOODRUFF RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4115
Mailing Address - Country:US
Mailing Address - Phone:864-438-2079
Mailing Address - Fax:864-234-4643
Practice Address - Street 1:1137 WOODRUFF RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4115
Practice Address - Country:US
Practice Address - Phone:864-438-2079
Practice Address - Fax:864-234-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9674Medicaid
SC8103Medicare PIN