Provider Demographics
NPI:1285621672
Name:HASSENPFLUG, DOUGLAS (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:HASSENPFLUG
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 1:108 BREAKER CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1803
Mailing Address - Country:US
Mailing Address - Phone:480-206-3740
Mailing Address - Fax:615-922-3740
Practice Address - Street 1:108 BREAKER CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1803
Practice Address - Country:US
Practice Address - Phone:480-206-3740
Practice Address - Fax:615-922-3740
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ67269Medicare ID - Type UnspecifiedMEDICARE/MEDICAID NUMBER
AZU86938Medicare UPIN