Active NPI
Gary Donald Haynie, MD
- Ophthalmology Physician
- Fargo, ND
National Provider Identifier
1487641817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 6710
- Practice address
- 4642 Amber Valley Pkwy S
Fargo, ND 58104-8612 - Phone
- (701) 277-4699
- Fax
- (701) 277-8357
- NPI assigned
- Sep 30, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 6710 | ND | Primary |
| Ophthalmology Physician | 207W00000X | 36803 | MN |
Addresses
Primary practice location
4642 Amber Valley Pkwy S
Fargo, ND 58104-8612
Mailing address
PO Box 11247
Fargo, ND 58106-1247
Phone (701) 277-4699
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11166 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36803 | MN | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192579200000",
"number": "1487641817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11247",
"city": "FARGO",
"state": "ND",
"postal_code": "581061247",
"telephone_number": "701-277-4699",
"fax_number": "701-277-8357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4642 AMBER VALLEY PKWY S",
"city": "FARGO",
"state": "ND",
"postal_code": "581048612",
"telephone_number": "701-277-4699",
"fax_number": "701-277-8357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYNIE",
"first_name": "GARY",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-30",
"last_updated": "2007-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "ND",
"license": "6710",
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MN",
"license": "36803",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11166",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.