Provider Demographics
NPI:1356388714
Name:HAYES, KATHLEEN JOYCE (OD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JOYCE
Last Name:HAYES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:HAYES
Other - Last Name:LEDESMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 NIBLICK RD
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-4842
Mailing Address - Country:US
Mailing Address - Phone:805-237-0275
Mailing Address - Fax:805-237-0274
Practice Address - Street 1:1315 LAS TABLAS RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9759
Practice Address - Country:US
Practice Address - Phone:805-239-4900
Practice Address - Fax:805-434-3037
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330470594OtherTAXPAYER ID
CAX22181Medicare UPIN
CAV05441Medicare PIN