=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235364316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAYES EYE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2009
-----------------------------------------------------
Last Update Date | 05/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2349 DANVILLE RD SW SUITE 410
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35603-4284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-353-2392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2012 MACK AVE SW
-----------------------------------------------------
City | CULLMAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35055-5512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-338-5490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DR. BRIDGET BOYD HAYES
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 256-338-5490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | S-B87-TA-801
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------