Provider Demographics
NPI:1861708034
Name:HAYNES, WILLIAM EARL (CERTIFIED OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EARL
Last Name:HAYNES
Suffix:
Gender:M
Credentials:CERTIFIED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 N 24TH ST
Mailing Address - Street 2:3008 N 24TH ST
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110
Mailing Address - Country:US
Mailing Address - Phone:402-451-0539
Mailing Address - Fax:
Practice Address - Street 1:3008 N 24TH ST
Practice Address - Street 2:3008 N 24TH ST
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-2026
Practice Address - Country:US
Practice Address - Phone:402-451-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE033114156FX1202X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4478Medicaid