Provider Demographics
NPI:1376831842
Name:WILLIS, HAILEY E (OD)
Entity Type:Individual
Prefix:DR
First Name:HAILEY
Middle Name:E
Last Name:WILLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6309
Mailing Address - Country:US
Mailing Address - Phone:903-455-0294
Mailing Address - Fax:903-455-2747
Practice Address - Street 1:5200 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6309
Practice Address - Country:US
Practice Address - Phone:903-455-0294
Practice Address - Fax:903-455-2747
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7875T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist