Provider Demographics
NPI:1366577793
Name:HAISLIP, ROBERT W (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:HAISLIP
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:4721 W PARK BLVD STE 99
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2391
Mailing Address - Country:US
Mailing Address - Phone:972-596-2250
Mailing Address - Fax:972-867-5441
Practice Address - Street 1:4721 W PARK BLVD STE 99
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2391
Practice Address - Country:US
Practice Address - Phone:972-596-2250
Practice Address - Fax:972-867-5441
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX01941T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist