Provider Demographics
NPI:1972598258
Name:HASS, WILLIAM B (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:HASS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-0068
Mailing Address - Country:US
Mailing Address - Phone:989-845-3835
Mailing Address - Fax:989-845-3982
Practice Address - Street 1:1180 W BROAD ST
Practice Address - Street 2:
Practice Address - City:CHESANING
Practice Address - State:MI
Practice Address - Zip Code:48616-1006
Practice Address - Country:US
Practice Address - Phone:989-845-3835
Practice Address - Fax:989-845-3982
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0G36400OtherMEDICARE ID
0G36400OtherMEDICARE ID
MIG3640001Medicare PIN