Provider Demographics
NPI:1275537771
Name:HAYES, SHELLY R (OD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:R
Last Name:HAYES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12 CHATHAM HEIGHTS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2566
Mailing Address - Country:US
Mailing Address - Phone:540-371-2777
Mailing Address - Fax:540-371-0922
Practice Address - Street 1:12 CHATHAM HEIGHTS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2566
Practice Address - Country:US
Practice Address - Phone:540-371-2777
Practice Address - Fax:540-371-0922
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA060100237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010005973Medicaid
VAU96307Medicare UPIN
VA002259A48Medicare ID - Type UnspecifiedOPTOMETRY