Provider Demographics
NPI:1699767038
Name:HAYES, BRIAN CARL (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CARL
Last Name:HAYES
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 1:121 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1552
Mailing Address - Country:US
Mailing Address - Phone:734-429-9454
Mailing Address - Fax:734-429-4100
Practice Address - Street 1:121 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1552
Practice Address - Country:US
Practice Address - Phone:734-429-9454
Practice Address - Fax:734-429-4100
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004009152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBH004009OtherBCBS MICHIGAN
MI900C848370OtherBCBSM
P00615116OtherRAILROAD MEDICARE
MI4471227Medicaid
MI4644712Medicaid
MIU79089Medicare UPIN
MIC84837020Medicare PIN