Provider Demographics
NPI:1982767281
Name:HAVILAND, THOMAS J (OD PC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:HAVILAND
Suffix:
Gender:M
Credentials:OD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 MONTCLAIR CT
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5348
Mailing Address - Country:US
Mailing Address - Phone:864-574-6727
Mailing Address - Fax:
Practice Address - Street 1:200 PEACHWOOD CENTRE DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5348
Practice Address - Country:US
Practice Address - Phone:864-574-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD07758Medicaid
SCD07758Medicaid
U26527Medicare UPIN