Provider Demographics
NPI:1477094944
Name:HAYLEY EYE CLINIC, P.C.
Entity Type:Organization
Organization Name:HAYLEY EYE CLINIC, P.C.
Other - Org Name:HAYLEY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-723-2020
Mailing Address - Street 1:1901 KEMP BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-3959
Mailing Address - Country:US
Mailing Address - Phone:940-723-2020
Mailing Address - Fax:940-723-6941
Practice Address - Street 1:1901 KEMP BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-3959
Practice Address - Country:US
Practice Address - Phone:940-723-2020
Practice Address - Fax:940-723-6941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019359101Medicaid
TX019359101Medicaid