Individual provider Active NPI

Diana L Haskins, O.D.

  • Optometrist
  • Benton Harbor, MI
National Provider Identifier
1811065469
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004811 Issued in MI
Practice address
1761 M 139
Benton Harbor, MI 49022-6101
Phone
(269) 934-0424
Fax
(269) 934-0570
NPI assigned
Dec 1, 2006
Last updated
Apr 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901004811 MI Primary
Corneal and Contact Management Optometrist 152WC0802X 046-008855 IL

Addresses

Primary practice location

1761 M 139
Benton Harbor, MI 49022-6101

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Other identifiers 1

IdentifierTypeStateIssuer
1811065469MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160726001638 MI Practitioner - Optometry 9830355304 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1995
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

1761 M
Suite 139
Benton Harbor, MI 49022-6101
Phone (269) 934-0424

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046-008855ILMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Michigan, LLC Optometrist CurrentSince May 3, 2021 Accepting new patients
Myeyedr Optometry of Michigan, LLC Optometrist CurrentSince May 3, 2021 Accepting new patients
Myeyedr Optometry of Michigan, LLC Optometrist Current Accepting new patients
Diana L Haskins Optometrist PastSince Aug 1, 2012 Accepting new patients

Locations

1761 M 139
Benton Harbor, MI 49022
Phone (269) 934-0424

800 S Brown St
Jackson, MI 49203
Phone (517) 787-8890

2008 Washington Ave
Saint Joseph, MI 49085
Phone (269) 983-1303

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1811065469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 M 139",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490226101",
            "telephone_number": "269-934-0424",
            "fax_number": "269-934-0570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASKINS",
        "first_name": "DIANA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004811",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "IL",
            "license": "046-008855",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811065469",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton Harbor, MI

Sources for this page

Verify at the official NPI Registry.