Organization
RETINA ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY DONALD HAYNIE M.D. (PRESIDENT)
(701) 277-4699
Entity
Organization
Contact information
Practice address
4642 AMBER VALLEY PKWY S, FARGO, ND 58104-8612
(701) 277-4699
(701) 277-8357
Mailing address
PO BOX 11247, FARGO, ND 58106-1247
(701) 277-4699
(701) 277-8357
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
6710
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11166
—
ND
Enumeration date
04/25/2007
Last updated
10/10/2007
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