Healthcare Provider Details

I. General information

NPI: 1396581872
Provider Name (Legal Business Name): HAILEY L. CHAMPION CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1974 HIGHWAY 160 S
HINDMAN KY
41822-9045
US

IV. Provider business mailing address

PO BOX 40
WHITESBURG KY
41858-0040
US

V. Phone/Fax

Practice location:
  • Phone: 606-629-4300
  • Fax: 606-629-3880
Mailing address:
  • Phone: 606-633-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2390DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: