Provider Demographics
NPI:1306833538
Name:HAINES, CARROLL F (MD)
Entity Type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:F
Last Name:HAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 THOMPSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5068
Mailing Address - Country:US
Mailing Address - Phone:336-627-5271
Mailing Address - Fax:336-623-5182
Practice Address - Street 1:515 THOMPSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5068
Practice Address - Country:US
Practice Address - Phone:336-627-5271
Practice Address - Fax:336-623-5182
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26004207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC38210OtherBLUECROSS AND BLUESHIELD
NC8938210Medicaid
NCC81369Medicare UPIN
NC0165460001Medicare NSC
NC202617CMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER