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General NPI Number Information
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NPI Number | 1427471515
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Entity Type | Organization
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Legal Business Name | DR. HAILEY E WILLIS, PLLC
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 5200 WESLEY ST
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City | GREENVILLE
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State | TX
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Zip | 75402-6309
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Country | US
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Telephone | 903-455-0294
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Fax | 903-455-2747
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Provider Business Mailing Address
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Address Line | 5200 WESLEY ST
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City | GREENVILLE
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State | TX
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Zip | 75402-6309
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Country | US
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Telephone | 903-455-0294
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Fax | 903-455-2747
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. HAILEY WILLIS
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Credential | O.D.
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Telephone | 903-455-0294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7875TG
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License Number State | TX
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