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General NPI Number Information
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NPI Number | 1447544200
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Entity Type | Organization
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Legal Business Name | CHARLENE L. HAYNES
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 16793 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78232-2349
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Country | US
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Telephone | 210-545-4772
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Fax | 210-545-5350
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Provider Business Mailing Address
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Address Line | 16793 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78232-2349
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Country | US
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Telephone | 210-545-4772
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Fax | 210-545-5350
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLENE L HAYNES
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Credential | OD, FAAO
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Telephone | 210-545-4772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 04268TG
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License Number State | TX
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