Provider Demographics
NPI:1144991191
Name:HALIFAX, PAULA (ABOC-AC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:HALIFAX
Suffix:
Gender:F
Credentials:ABOC-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7336 TRACY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1734
Mailing Address - Country:US
Mailing Address - Phone:816-872-8450
Mailing Address - Fax:
Practice Address - Street 1:7336 TRACY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1734
Practice Address - Country:US
Practice Address - Phone:816-872-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
233166156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician