Provider Demographics
NPI:1437315785
Name:HALSEY, P.C.
Entity Type:Organization
Organization Name:HALSEY, P.C.
Other - Org Name:DAVID J. HALSEY, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-322-9747
Mailing Address - Street 1:404 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-2910
Mailing Address - Country:US
Mailing Address - Phone:307-322-9747
Mailing Address - Fax:307-322-7996
Practice Address - Street 1:404 9TH ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-2910
Practice Address - Country:US
Practice Address - Phone:307-322-9747
Practice Address - Fax:307-322-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY110T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106322700Medicaid
WY106322700Medicaid
WYW22050Medicare UPIN
WY0790700002Medicare NSC