Provider Demographics
NPI:1285656082
Name:HALEY, BILLY D (OD)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:D
Last Name:HALEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 1290
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1290
Mailing Address - Country:US
Mailing Address - Phone:434-385-5600
Mailing Address - Fax:434-455-7172
Practice Address - Street 1:1825 GRAVES MILL RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-3967
Practice Address - Country:US
Practice Address - Phone:434-385-5600
Practice Address - Fax:434-455-7172
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009232346Medicaid
VAU57745Medicare UPIN
VA009232346Medicaid