Healthcare Provider Details

I. General information

NPI: 1285671842
Provider Name (Legal Business Name): JUDITH LEE HAINLINE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 N FEDERAL HWY SUITE 402
FT LAUDERDALE FL
33308-1412
US

IV. Provider business mailing address

6405 N FEDERAL HWY SUITE 402
FT LAUDERDALE FL
33308-1412
US

V. Phone/Fax

Practice location:
  • Phone: 954-492-1177
  • Fax: 954-492-0352
Mailing address:
  • Phone: 954-492-1177
  • Fax: 954-492-0352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number19844Z
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: