Provider Demographics
NPI:1326595208
Name:JEANINE HAYEN OD LLC
Entity Type:Organization
Organization Name:JEANINE HAYEN OD LLC
Other - Org Name:COLLEGE PARK EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMESTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-271-4455
Mailing Address - Street 1:720 RUGBY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4900
Mailing Address - Country:US
Mailing Address - Phone:407-271-4455
Mailing Address - Fax:407-271-4147
Practice Address - Street 1:720 RUGBY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4900
Practice Address - Country:US
Practice Address - Phone:407-271-4455
Practice Address - Fax:407-271-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4323152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty