Provider Demographics
NPI:1689641342
Name:HAIVALA, DARIN R (MD)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:R
Last Name:HAIVALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:405-752-0711
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21377207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100187820BMedicaid
OK100187820BMedicaid
OK243431502Medicare PIN
P00169483Medicare PIN