Provider Demographics
NPI:1992238422
Name:SHAFFER, HAILEY SARAH (OD)
Entity type:Individual
Prefix:DR
First Name:HAILEY
Middle Name:SARAH
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HAILEY
Other - Middle Name:SARAH
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:501 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2006
Mailing Address - Country:US
Mailing Address - Phone:574-583-9311
Mailing Address - Fax:
Practice Address - Street 1:501 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2006
Practice Address - Country:US
Practice Address - Phone:574-583-9311
Practice Address - Fax:574-583-4939
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist