Provider Demographics
NPI:1407908767
Name:HALEY, BECKY SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:SUE
Last Name:HALEY
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 1:920 MENG DR
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3858
Mailing Address - Country:US
Mailing Address - Phone:970-867-9299
Mailing Address - Fax:
Practice Address - Street 1:231 PROSPECT ST STE B
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3160
Practice Address - Country:US
Practice Address - Phone:970-867-3937
Practice Address - Fax:970-867-3037
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 1459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU542014Medicare UPIN
CO43763Medicare ID - Type Unspecified