MEDICARE: DR. HALEY A DUHAIME 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	5513	OH

General Provider Information

NPI Number	:	1508867953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HALEY A DUHAIME O.D.

Provider Business Mailing Address
First Line	:	6140 SCHLONEGER DR
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9064
Country	:	US
Telephone Number	:	614-395-1265
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 E MAIN ST
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-1421
Country	:	US
Telephone Number	:	330-875-2300
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/29/2019

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