Provider Demographics
NPI:1871071241
Name:BALDRIDGE, HALEY L (OD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:L
Last Name:BALDRIDGE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:L
Other - Last Name:KINCANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1405 S GALVESTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-2415
Mailing Address - Country:US
Mailing Address - Phone:580-467-0678
Mailing Address - Fax:
Practice Address - Street 1:224 S GATEWAY PL
Practice Address - Street 2:SUITE 101
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3448
Practice Address - Country:US
Practice Address - Phone:918-747-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist