Healthcare Provider Details

I. General information

NPI: 1699860007
Provider Name (Legal Business Name): HOWARD LEON HALL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GILLHAM AVE
MENA AR
71953-4137
US

IV. Provider business mailing address

701 GILLHAM ST.
MENA AR
71953-0778
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-7771
  • Fax: 479-394-7770
Mailing address:
  • Phone: 479-394-7771
  • Fax: 479-394-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2078
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: