Healthcare Provider Details

I. General information

NPI: 1285656082
Provider Name (Legal Business Name): BILLY D HALEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DOUGLAS HALEY OD

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 GRAVES MILL RD
FOREST VA
24551-3967
US

IV. Provider business mailing address

PO BOX 45923
BALTIMORE MD
21297-5923
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-5600
  • Fax: 434-455-7172
Mailing address:
  • Phone: 434-385-5600
  • Fax: 434-455-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000386
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0620000089
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: