Provider Demographics
NPI:1952603805
Name:HAYNES, STEPHEN WESTGATE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WESTGATE
Last Name:HAYNES
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 1:415 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2215
Mailing Address - Country:US
Mailing Address - Phone:541-720-0234
Mailing Address - Fax:
Practice Address - Street 1:415 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2215
Practice Address - Country:US
Practice Address - Phone:541-720-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3389AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist