Provider Demographics
NPI:1598139164
Name:DAVIS C HAIRE
Entity Type:Organization
Organization Name:DAVIS C HAIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-836-2020
Mailing Address - Street 1:10 TRIEBLE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-7054
Mailing Address - Country:US
Mailing Address - Phone:570-836-2020
Mailing Address - Fax:570-836-5501
Practice Address - Street 1:10 TRIEBLE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7054
Practice Address - Country:US
Practice Address - Phone:570-836-2020
Practice Address - Fax:570-836-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000952152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007313670003Medicaid
PA029973Medicare PIN