Individual
DR. HALEY PENROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
131 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2540
(770) 994-9913
Mailing address
4056 IDLEVALE DR, TUCKER, GA 30084-7815
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2428
AZ
152W00000X
Optometrist
3045
GA
152WV0400X
Vision Therapy Optometrist
OPT003045
GA
Other
Enumeration date
07/14/2017
Last updated
10/06/2020
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