Provider Demographics
NPI:1811046667
Name:HAYLEY EYE CLINIC, P.C.
Entity type:Organization
Organization Name:HAYLEY EYE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-723-2020
Mailing Address - Street 1:1901 KEMP BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309
Mailing Address - Country:US
Mailing Address - Phone:940-723-2020
Mailing Address - Fax:940-723-6941
Practice Address - Street 1:1901 KEMP BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-3959
Practice Address - Country:US
Practice Address - Phone:940-723-2020
Practice Address - Fax:940-723-6941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2530TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13755Medicare UPIN
TX0972170001Medicare NSC
TXU51089Medicare UPIN