MEDICARE: DR. BECKY SUE 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	OPT 1459	CO

General Provider Information

NPI Number	:	1407908767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BECKY SUE HALEY O.D.

Provider Business Mailing Address
First Line	:	920 MENG DR
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-3858
Country	:	US
Telephone Number	:	970-867-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 PROSPECT ST STE B
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-3160
Country	:	US
Telephone Number	:	970-867-3937
Fax Number	:	970-867-3037

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	12/24/2009

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