Individual
DR. JOHN CHARLES HAESEKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
11550 MERIDIAN MARKET VIEW, WALMART VISION CENTER #4335, PEYTON, CO 80831-8233
(719) 495-5055
(719) 495-0574
Mailing address
11550 MERIDIAN MARKET VIEW, WALMART VISION CENTER #4335, PEYTON, CO 80831-8233
(719) 495-5055
(719) 495-0574
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1476
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13227271
—
CO
01
—
85628379
MEDICAID PIN
CO
01
—
C482908
MEDICARE GROUP
—
Enumeration date
05/08/2006
Last updated
11/14/2007
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