Provider Demographics
NPI:1619933785
Name:SPRAGUE, HAYLEY A (OD)
Entity Type:Individual
Prefix:DR
First Name:HAYLEY
Middle Name:A
Last Name:SPRAGUE
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 1:9 S LAKE TER
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4155
Mailing Address - Country:US
Mailing Address - Phone:302-227-2646
Mailing Address - Fax:
Practice Address - Street 1:502 W MARKET ST
Practice Address - Street 2:STE A
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2322
Practice Address - Country:US
Practice Address - Phone:302-856-2020
Practice Address - Fax:302-856-4970
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00339755Medicare PIN
DE019574S30Medicare PIN
U97398Medicare UPIN
DE0924150001Medicare NSC