Provider Demographics
NPI:1861807364
Name:MCCREERY, HALEY LONG (OD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:LONG
Last Name:MCCREERY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 HIGHWAY MM
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-5110
Mailing Address - Country:US
Mailing Address - Phone:573-280-5649
Mailing Address - Fax:
Practice Address - Street 1:1211 HAUCK DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4900
Practice Address - Country:US
Practice Address - Phone:573-364-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014020352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist