Provider Demographics
NPI:1750493987
Name:HAINES, JAMES LESLIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LESLIE
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 1:1120 W OAK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1259
Mailing Address - Country:US
Mailing Address - Phone:317-873-3000
Mailing Address - Fax:317-733-2020
Practice Address - Street 1:1120 W OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1259
Practice Address - Country:US
Practice Address - Phone:317-873-3000
Practice Address - Fax:317-733-2020
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100063260AMedicaid
IN000000233731OtherANTHEM
T34530Medicare UPIN
194640AMedicare ID - Type Unspecified