Provider Demographics
NPI:1619991692
Name:HALEY, CHAUNCEY B (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAUNCEY
Middle Name:B
Last Name:HALEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2102
Mailing Address - Country:US
Mailing Address - Phone:660-826-4774
Mailing Address - Fax:888-979-8868
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-3821
Practice Address - Country:US
Practice Address - Phone:660-310-0909
Practice Address - Fax:888-979-8868
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE1209152W00000X
MO2003019276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37103OtherNEBRASKA BCBS
NE37119OtherNEBRASKA BCBS