MEDICARE: DEBORAH A HAYDEN 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	152WC0802X	Corneal and Contact Management Optometrist	1664	NC
2	152W00000X	Optometrist	1664	NC

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	:	1720001399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH A HAYDEN O.D.

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD 520
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3970
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	703-991-0514

Provider Business Practice Location Address
First Line	:	1031 GRANDIFLORA DR
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-7453
Country	:	US
Telephone Number	:	910-371-0540
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	11/03/2020

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