Rayburn S Haddon III, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4393 Issued in TX

Practice address

4824 S Broadway Ave
Tyler, TX 75703-1312

Phone

(901) 358-1202

NPI assigned

Dec 11, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355184000000",
    "number": "1861737272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4824 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031312",
            "telephone_number": "901-358-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4824 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031312",
            "telephone_number": "901-358-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDON",
        "first_name": "RAYBURN",
        "middle_name": "S",
        "name_suffix": "III",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-11",
        "last_updated": "2012-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "4393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Camilla Ha, LPC-A
• Charles Daniel Haas, MD
• Paul C Hable, M.D.
• Bethany Hackett
• McKenzie Hackmaster, DO
• Soheil Haftbaradaran
• Daniela Hagenasr, DO
• Tan Haigh, DO
• Rama Hailat
• Donna Jo Haire, COTA

• Optometrist in Tyler, TX
• Providers in Tyler, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.