Provider Demographics
NPI:1144333675
Name:HALEY, MICHELE LEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LEIGH
Last Name:HALEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:LEIGH
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:211 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6220
Mailing Address - Country:US
Mailing Address - Phone:618-462-9818
Mailing Address - Fax:800-432-6004
Practice Address - Street 1:323 MONROE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3105
Practice Address - Country:US
Practice Address - Phone:573-635-1313
Practice Address - Fax:573-634-8500
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001021461152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO315428946Medicaid
MOMRO774225OtherDEA
MOU91891Medicare UPIN