Provider Demographics
NPI:1477667558
Name:HAWS, KAYLE L (OD)
Entity Type:Individual
Prefix:DR
First Name:KAYLE
Middle Name:L
Last Name:HAWS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EAGAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85925-9847
Mailing Address - Country:US
Mailing Address - Phone:928-333-4396
Mailing Address - Fax:928-341-0881
Practice Address - Street 1:39 E 1ST ST
Practice Address - Street 2:
Practice Address - City:EAGAR
Practice Address - State:AZ
Practice Address - Zip Code:85925-9847
Practice Address - Country:US
Practice Address - Phone:928-333-4396
Practice Address - Fax:928-341-0881
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1530152W00000X
AZOPT-001530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ116410Medicaid
AZ116410Medicaid
AZV10355Medicare UPIN