MEDICARE: DR. MICHELE LEIGH HALEY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2001021461	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144333675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE LEIGH HALEY O.D.

Provider Business Mailing Address
First Line	:	211 E BROADWAY
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6220
Country	:	US
Telephone Number	:	618-462-9818
Fax Number	:	800-432-6004

Provider Business Practice Location Address
First Line	:	323 MONROE ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-3105
Country	:	US
Telephone Number	:	573-635-1313
Fax Number	:	573-634-8500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	03/07/2023

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