Provider Demographics
NPI:1447430921
Name:HAYNES, CHRYSTIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRYSTIE
Middle Name:
Last Name:HAYNES
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 1:20615 WHITEHALL TER
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1720
Mailing Address - Country:US
Mailing Address - Phone:646-734-1572
Mailing Address - Fax:
Practice Address - Street 1:888 WORCESTER ST
Practice Address - Street 2:C/O HEALTHDRIVE
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-3717
Practice Address - Country:US
Practice Address - Phone:617-964-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3246 AT152W00000X
MA4884 TP152W00000X
NY007236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist