Individual
JEREMY HAUPTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
9069 W THUNDERBIRD RD, PEORIA, AZ 85381-4412
(623) 977-7201
(623) 876-2129
Mailing address
25500 N NORTERRA DR, PHOENIX, AZ 85085-8200
(623) 277-1130
(866) 837-6575
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2198
AZ
152W00000X
Optometrist
2932
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
396097
—
AZ
Enumeration date
07/19/2017
Last updated
05/05/2021
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