Provider Demographics
NPI:1457541187
Name:HAIMAN, PHILLIP KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:KEITH
Last Name:HAIMAN
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 1:10020 MANDARIN ST
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3941
Mailing Address - Country:US
Mailing Address - Phone:954-336-8903
Mailing Address - Fax:
Practice Address - Street 1:12555 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-0900
Practice Address - Country:US
Practice Address - Phone:954-845-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3650152WC0802X
FLOPC3650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist