Provider Demographics
NPI:1366694648
Name:HAYNES, CYNTHIA
Entity type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 NEWTOWN RD STE 108
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1683
Mailing Address - Country:US
Mailing Address - Phone:757-473-3511
Mailing Address - Fax:757-473-3470
Practice Address - Street 1:665 NEWTOWN RD STE 108
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1683
Practice Address - Country:US
Practice Address - Phone:757-473-3511
Practice Address - Fax:757-473-3470
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001947156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician