Provider Demographics
NPI:1700907136
Name:HAAS, LARRY D
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:D
Last Name:HAAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2286 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2335
Mailing Address - Country:US
Mailing Address - Phone:614-237-2200
Mailing Address - Fax:614-237-2422
Practice Address - Street 1:2286 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2335
Practice Address - Country:US
Practice Address - Phone:614-237-2200
Practice Address - Fax:614-237-2422
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1021S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4511530001Medicare NSC