Provider Demographics
NPI:1992328900
Name:MATHEWS, HALEY (OD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:MATHEWS
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 1:915 ROBINS SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ROBINS
Mailing Address - State:IA
Mailing Address - Zip Code:52328-9649
Mailing Address - Country:US
Mailing Address - Phone:319-294-8888
Mailing Address - Fax:319-294-4299
Practice Address - Street 1:510 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1207
Practice Address - Country:US
Practice Address - Phone:319-365-2868
Practice Address - Fax:319-365-7831
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100710152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1598019408Medicaid