Provider Demographics
NPI:1194858217
Name:HAYDEN, JEFF (OD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1516
Mailing Address - Country:US
Mailing Address - Phone:810-227-2004
Mailing Address - Fax:810-227-9910
Practice Address - Street 1:420 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1516
Practice Address - Country:US
Practice Address - Phone:810-227-2004
Practice Address - Fax:810-227-9910
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003926152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9446210660226Medicaid
MI6074730001OtherMEDICARE DME