Provider Demographics
NPI:1730160722
Name:HAUGEN, SCOTT (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
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 1:645 S WHITCOMB ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3645
Mailing Address - Country:US
Mailing Address - Phone:970-221-0808
Mailing Address - Fax:970-221-0802
Practice Address - Street 1:645 S WHITCOMB ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-3645
Practice Address - Country:US
Practice Address - Phone:970-221-0808
Practice Address - Fax:970-221-0802
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC41623Medicare PIN
CO0588360001Medicare NSC