MEDICARE: KANDACE LAUREN HAINES O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC4650	FL

General Provider Information

NPI Number	:	1215211073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDACE LAUREN HAINES O.D.

Provider Business Mailing Address
First Line	:	900 E ATLANTIC AVE
Second Line	:	STE. 17
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6954
Country	:	US
Telephone Number	:	561-265-2020
Fax Number	:	561-258-0141

Provider Business Practice Location Address
First Line	:	900 E ATLANTIC AVE
Second Line	:	STE. 17
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6954
Country	:	US
Telephone Number	:	561-265-2020
Fax Number	:	561-258-0141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	04/02/2016

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