Provider Demographics
NPI:1902931900
Name:HALSEY, DAVID J (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:HALSEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-2910
Mailing Address - Country:US
Mailing Address - Phone:307-322-9747
Mailing Address - Fax:307-322-9776
Practice Address - Street 1:404 9TH ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-2910
Practice Address - Country:US
Practice Address - Phone:307-322-9747
Practice Address - Fax:307-322-9776
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY110T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106322700Medicaid
WYW22050Medicare UPIN
WY0790700002Medicare NSC