Jonathan D Haley, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60843163 Issued in WA

Practice address

1610 Penny LN
Walla Walla, WA 99362

Phone

(509) 540-3937

Fax

(509) 540-3938

NPI assigned

Mar 11, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blue Mountain Eye PLLC

  dba Lifestyle Eye Center

  • Ophthalmology Physician
  • Walla Walla, WA
  • NPI 1255631016

  OR

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548288000000",
    "number": "1871919167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX O",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993620212",
            "telephone_number": "509-540-3937",
            "fax_number": "509-540-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 PENNY LN",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "99362",
            "telephone_number": "509-540-3937",
            "fax_number": "509-540-3938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4102 Pinion Dr # 10Mdg",
            "address_purpose": "LOCATION",
            "city": "Usaf Academy",
            "state": "CO",
            "postal_code": "808402502",
            "country_code": "US",
            "telephone_number": "719-333-9293",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1070 W Elm Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Hermiston",
            "state": "OR",
            "postal_code": "978382711",
            "country_code": "US",
            "telephone_number": "509-540-3937",
            "fax_number": "509-540-3938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALEY",
        "first_name": "JONATHAN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-11",
        "last_updated": "2019-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT.0003066",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "39083",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60843163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Margaret Hale, PHARMD
• Brenda Carol Hall, RN, CNOR
• Christopher P Hall, M.D.
• Maygen Hall
• Keren Hallowell
• Madelyn Hallowell

• Optometrist in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.