Provider Demographics
NPI:1285619965
Name:HAINE, DAVID ARTHUR (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARTHUR
Last Name:HAINE
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 1:306 ENGLAND ST
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 ST
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
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1315360001Medicare NSC
U69905Medicare UPIN