Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC4949 | FL |
NPI | 1013322627 |
---|---|
Provider Name | Dr. Jalene Haynes |
First Address | Daytona Beach, FL 32117-5116 |
Second Address | Daytona Beach, FL 32117-5116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 01/07/2014 |