Provider Demographics
NPI:1508818113
Name:HAYES, CORREEN LEEANN (OD)
Entity Type:Individual
Prefix:DR
First Name:CORREEN
Middle Name:LEEANN
Last Name:HAYES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CORREEN
Other - Middle Name:LEEANN
Other - Last Name:BRIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1007 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1420
Mailing Address - Country:US
Mailing Address - Phone:231-924-1988
Mailing Address - Fax:231-924-1622
Practice Address - Street 1:1007 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1420
Practice Address - Country:US
Practice Address - Phone:231-924-1988
Practice Address - Fax:231-924-1622
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3858OtherEYEMED
MI0F26509OtherBCBSM
MIMI3858OtherVBA
MIMI3858OtherVBA
MIU78263Medicare UPIN