Provider Demographics
NPI:1104902923
Name:HAISMAN, DAVID RAY (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:HAISMAN
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 1:2200 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360
Mailing Address - Country:US
Mailing Address - Phone:712-336-8939
Mailing Address - Fax:712-336-8952
Practice Address - Street 1:2200 17TH ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360
Practice Address - Country:US
Practice Address - Phone:712-336-8939
Practice Address - Fax:712-336-8952
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009582152W00000X
IA002415152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist