Provider Demographics
NPI:1518906346
Name:HAINES, MICHAEL JOSEPH (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:HAINES
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 1:1317 N BRIGHTLEAF BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-7267
Mailing Address - Country:US
Mailing Address - Phone:919-934-2020
Mailing Address - Fax:919-934-7370
Practice Address - Street 1:1317 N BRIGHTLEAF BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-7267
Practice Address - Country:US
Practice Address - Phone:919-934-2020
Practice Address - Fax:919-934-7370
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
09350OtherBCBS
NC8909350Medicaid
NC246576Medicare ID - Type Unspecified
09350OtherBCBS
NC8909350Medicaid