Provider Demographics
NPI:1821047994
Name:HAYDEN, DANIEL L (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:HAYDEN
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 1:195 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5801
Mailing Address - Country:US
Mailing Address - Phone:217-224-7732
Mailing Address - Fax:217-224-4468
Practice Address - Street 1:195 S 36TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5801
Practice Address - Country:US
Practice Address - Phone:217-224-7732
Practice Address - Fax:217-214-9437
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL166876OtherHEALTHLINK
IL046009104Medicaid
IL49314OtherHEALTH ALLIANCE
MO315345405Medicaid
IL121397OtherBLUE CROSS/SHIELD OF IL
IL410042833Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL121397OtherBLUE CROSS/SHIELD OF IL
IL166876OtherHEALTHLINK
IL046009104Medicaid