Provider Demographics
NPI:1316915341
Name:HAUG, MICHAEL JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:HAUG
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 1:316 W MISSION AVE
Mailing Address - Street 2:SUITE #118
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1731
Mailing Address - Country:US
Mailing Address - Phone:760-746-7752
Mailing Address - Fax:760-737-6879
Practice Address - Street 1:316 W MISSION AVE
Practice Address - Street 2:SUITE #118
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1731
Practice Address - Country:US
Practice Address - Phone:760-746-7752
Practice Address - Fax:760-737-6879
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10202TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18839OtherMEDICAL EYE SERVICES
CABS665ZOtherMEDICARE PTAN
CABS665ZOtherMEDICARE PTAN