Provider Demographics
NPI:1982044319
Name:HAINES, STEFANIE A (OD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:A
Last Name:HAINES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:A
Other - Last Name:NAUMOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7802
Mailing Address - Country:US
Mailing Address - Phone:856-691-8188
Mailing Address - Fax:856-500-6001
Practice Address - Street 1:251 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7802
Practice Address - Country:US
Practice Address - Phone:856-691-8188
Practice Address - Fax:856-500-6001
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00645800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist