Individual
CHARLES HAINE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1225 MADISON AVE, MPHS, TN 38104-2211
(901) 722-3250
(901) 722-3347
Mailing address
1225 MADISON AVE, MPHS, TN 38104-2211
(901) 722-3250
(901) 722-3347
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1903
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1903
OD
TN
05
—
3942033
—
TN
Enumeration date
08/24/2005
Last updated
03/07/2023
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