Provider Demographics
NPI:1972733558
Name:HAAS, STEPHANIE LEIGH (OD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:HAAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8084 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8024
Mailing Address - Country:US
Mailing Address - Phone:614-864-3937
Mailing Address - Fax:614-864-9008
Practice Address - Street 1:8084 E BROAD ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8024
Practice Address - Country:US
Practice Address - Phone:614-864-3937
Practice Address - Fax:614-864-9008
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4298672Medicare PIN
OH4298671Medicare PIN