MEDICARE: DR. VICTORIA V. 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	OPC2656	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0002644	OTHER	FL	OPTOMETRIST PRESCRIBER #
2	OPC2656	OTHER	FL	CERTIFIED OPTOMETRIST

General Provider Information

NPI Number	:	1447365085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA V. HAINES O.D.

Provider Business Mailing Address
First Line	:	9375 66TH ST N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-4418
Country	:	US
Telephone Number	:	727-541-4469
Fax Number	:	727-546-9661

Provider Business Practice Location Address
First Line	:	9375 66TH ST N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-4418
Country	:	US
Telephone Number	:	727-541-4469
Fax Number	:	727-546-9661

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/21/2022

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