Provider Demographics
NPI:1215211073
Name:HAINES, KANDACE LAUREN (OD)
Entity Type:Individual
Prefix:
First Name:KANDACE
Middle Name:LAUREN
Last Name:HAINES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E ATLANTIC AVE
Mailing Address - Street 2:STE. 17
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-6954
Mailing Address - Country:US
Mailing Address - Phone:561-265-2020
Mailing Address - Fax:561-258-0141
Practice Address - Street 1:900 E ATLANTIC AVE
Practice Address - Street 2:STE. 17
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6954
Practice Address - Country:US
Practice Address - Phone:561-265-2020
Practice Address - Fax:561-258-0141
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist