Provider Demographics
NPI:1144491788
Name:DAVID A. HAINE, O.D. P.C.
Entity type:Organization
Organization Name:DAVID A. HAINE, O.D. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:HAINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-798-8593
Mailing Address - Street 1:306 ENGLAND STREET
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2110
Mailing Address - Country:US
Mailing Address - Phone:804-798-8593
Mailing Address - Fax:804-798-4052
Practice Address - Street 1:306 ENGLAND STREET
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2110
Practice Address - Country:US
Practice Address - Phone:804-798-8593
Practice Address - Fax:804-798-4052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID A HAINE OD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-21
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009235027Medicaid
410001142Medicare PIN
1315360001Medicare NSC
U69905Medicare UPIN