Provider Demographics
NPI:1902896558
Name:HAUGEN, MICHAEL B (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:HAUGEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11380 PROSPERITY FARMS RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3464
Mailing Address - Country:US
Mailing Address - Phone:561-627-1114
Mailing Address - Fax:561-627-2304
Practice Address - Street 1:11380 PROSPERITY FARMS RD
Practice Address - Street 2:SUITE 119
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3464
Practice Address - Country:US
Practice Address - Phone:561-627-1114
Practice Address - Fax:561-627-2304
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078980100Medicaid
FL0466910001Medicare NSC
T85265Medicare UPIN
FL19389ZMedicare PIN