MEDICARE: BILLY D HALEY OD

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	0618000386	VA
2	152W00000X	Optometrist	0620000089	VA

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	:	1285656082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLY D HALEY OD

Provider Business Mailing Address
First Line	:	PO BOX 45923
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-5923
Country	:	US
Telephone Number	:	434-385-5600
Fax Number	:	434-455-7172

Provider Business Practice Location Address
First Line	:	1825 GRAVES MILL RD
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-3967
Country	:	US
Telephone Number	:	434-385-5600
Fax Number	:	434-455-7172

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	12/15/2025

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