Provider Demographics
NPI:1801839477
Name:HAYES, MICHAEL LYNN (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYNN
Last Name:HAYES
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 1:310 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1102
Mailing Address - Country:US
Mailing Address - Phone:270-527-9983
Mailing Address - Fax:270-527-9593
Practice Address - Street 1:310 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1102
Practice Address - Country:US
Practice Address - Phone:270-527-9983
Practice Address - Fax:270-527-9593
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1318DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77013183Medicaid
KY1866401Medicare ID - Type Unspecified