John Charles Haeseker, OD
Individual provider Active NPI Optometrist · Peyton, CO
NPI 1659320752 · NPPES record last updated Nov 14, 2007
Key facts
- NPI
- 1659320752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1476 (CO)
- Practice address
- 11550 Meridian Market View
Walmart Vision Center #4335
Peyton, CO 80831-8233 - Phone
- (719) 495-5055
- Fax
- (719) 495-0574
- NPI assigned
- May 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120319000092 | CO | Practitioner - Optometry | 1951293133 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1476 | CO | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John C. Haeseker, O.D. PC | Optometrist | Current |
Accepting new patients |
Locations
11550 Meridian Market Vw
#4335
Peyton, CO 80831
Phone (719) 495-5055
11550 Meridian Market Vw
Peyton, CO 80831
Phone (719) 495-5055
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1476 | CO | Yes |
Addresses
Primary practice location
11550 Meridian Market View
Walmart Vision Center #4335
Peyton, CO 80831-8233
Mailing address
11550 Meridian Market View
Walmart Vision Center #4335
Peyton, CO 80831-8233
Phone (719) 495-5055
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13227271 | Medicaid | CO | |
| C482908 | Other | MEDICARE GROUP | |
| 85628379 | Other | CO | MEDICAID PIN |
Other providers in Peyton, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.