Edward Haack, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

10326T Issued in CA

Practice address

1102 Magnolia Ave
Larkspur, CA 94939-1054

Phone

(415) 891-9090

Fax

(415) 891-9080

NPI assigned

Aug 23, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Larkspur Landing Optometric Corporation

  • Optometrist
  • Larkspur, CA
  • NPI 1801033691
  NPD (past) Authorized official
• Larkspur Landing Optometry

  • Vision Therapy Optometrist
  • Larkspur, CA
  • NPI 1306837117
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490659200000",
    "number": "1174516462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 MAGNOLIA AVE",
            "city": "LARKSPUR",
            "state": "CA",
            "postal_code": "949391054",
            "telephone_number": "415-891-9090",
            "fax_number": "415-891-9080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 MAGNOLIA AVE",
            "city": "LARKSPUR",
            "state": "CA",
            "postal_code": "949391054",
            "telephone_number": "415-891-9090",
            "fax_number": "415-891-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAACK",
        "first_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2017-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10326T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0103260",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Greenway, NP
• Trevor Charles Greenwood, PT
• Adhira Gupta, MD
• Matthew Samuel Carlton Gutierrez, PHARM.D.
• H.O.P.E. for Healing Institute (a 501C3 Not for Profit)
• Frederike Haeusserman, P.T.
• Theresa Hall, LMFT
• Madeleine Hanks
• Margo Elizabeth Hanlan, PNP
• John Marshall Harvey, MD

• Optometrist in Larkspur, CA
• Providers in Larkspur, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.