Provider Demographics
NPI:1285671842
Name:HAINLINE, JUDITH LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LEE
Last Name:HAINLINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6405 N FEDERAL HWY
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1412
Mailing Address - Country:US
Mailing Address - Phone:954-492-1177
Mailing Address - Fax:954-492-0352
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:SUITE 402
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:954-492-1177
Practice Address - Fax:954-492-0352
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19844Z152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist