Provider Demographics
NPI:1942409966
Name:ARTHUR A. HALEY, O.D. PSC
Entity Type:Organization
Organization Name:ARTHUR A. HALEY, O.D. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-469-4393
Mailing Address - Street 1:68 WELLNESS LN
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-7650
Mailing Address - Country:US
Mailing Address - Phone:270-469-4393
Mailing Address - Fax:270-469-1050
Practice Address - Street 1:68 WELLNESS LN
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-7650
Practice Address - Country:US
Practice Address - Phone:270-469-4393
Practice Address - Fax:270-469-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1181DT332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77011815Medicaid
KY77011815Medicaid
KY9301Medicare PIN