Provider Demographics
NPI:1669575361
Name:HAYES, TINA GAY (OD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:GAY
Last Name:HAYES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:GAY
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1617 N WEST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2030
Practice Address - Country:US
Practice Address - Phone:517-780-3828
Practice Address - Fax:517-780-4959
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI 4901003758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M31930Medicare ID - Type Unspecified
MIU64255Medicare UPIN