Provider Demographics
NPI:1588123590
Name:WATSON HAYES LLC
Entity type:Organization
Organization Name:WATSON HAYES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:267-736-6335
Mailing Address - Street 1:4523 N 3150 E
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:UT
Mailing Address - Zip Code:84310-9779
Mailing Address - Country:US
Mailing Address - Phone:267-736-6335
Mailing Address - Fax:
Practice Address - Street 1:111 S 24TH ST W STE 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5659
Practice Address - Country:US
Practice Address - Phone:406-656-2006
Practice Address - Fax:406-655-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1588990295OtherNPI