Provider Demographics
NPI:1457672545
Name:DARIN R. HAIVALA, MD, PLLC
Entity Type:Organization
Organization Name:DARIN R. HAIVALA, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAIVALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-752-0717
Mailing Address - Street 1:12318 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8604
Mailing Address - Country:US
Mailing Address - Phone:405-752-0717
Mailing Address - Fax:
Practice Address - Street 1:12318 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8604
Practice Address - Country:US
Practice Address - Phone:405-752-0717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-13
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty