Provider Demographics
NPI:1528677481
Name:HAAS, RONALD JR (LICENSED OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:HAAS
Suffix:JR
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FULMORE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1504
Mailing Address - Country:US
Mailing Address - Phone:203-500-9713
Mailing Address - Fax:
Practice Address - Street 1:24 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-3231
Practice Address - Country:US
Practice Address - Phone:203-500-9713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001759156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician