NPIMap

Organization Active NPI

Dr. Michael J. Haynes a Professional Corporation

  • Optometrist
  • Monroe, LA
National Provider Identifier
1700059656
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
891-26T Issued in LA
Legal business name
DR. MICHAEL J. HAYNES A PROFESSIONAL CORPORATION
Practice address
2808 Forsythe Avenue
Monroe, LA 71201-3008
Phone
(318) 323-4994
Fax
(318) 388-6913
NPI assigned
Apr 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael J Haynes, ODNPI 1407859440
Title
President
Phone
(318) 323-4994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 891-26T LA Primary

Addresses

Primary practice location

2808 Forsythe Avenue
Monroe, LA 71201-3008

Mailing address

2808 Forsythe Avenue
Monroe, LA 71201-3008
Phone (318) 323-4994

Other identifiers 1

IdentifierTypeStateIssuer
1326879MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090707000132 LA Part B Supplier - Clinic/Group Practice 5496806382 Receives reassigned benefits from 1 practitioner
Practice locations: Monroe, LA
O20100930097818 LA DME Supplier - Physician - Optometrist 5496806382 1 other NPI on this enrollment
Practice locations: Monroe, LA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Dr. Michael J. Haynes2808 Forsythe Avenue, Monroe, LA 71201-3008(318) 323-4994 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Apr 26, 2009

National Provider Directory

National Provider Directory

Locations

2808 Forsythe Ave
Monroe, LA 71201
Phone (318) 323-4994

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1700059656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 FORSYTHE AVENUE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013008",
            "telephone_number": "318-323-4994",
            "fax_number": "318-388-6913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2808 FORSYTHE AVENUE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013008",
            "telephone_number": "318-323-4994",
            "fax_number": "318-388-6913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MICHAEL J. HAYNES A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-10",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-323-4994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "LA",
            "license": "891-26T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326879",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.