Healthcare Provider Details

I. General information

NPI: 1194398602
Provider Name (Legal Business Name): ANDREW HALTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 SOLANO AVE
ALBANY CA
94706-1650
US

IV. Provider business mailing address

1051 SOLANO AVE
ALBANY CA
94706-1650
US

V. Phone/Fax

Practice location:
  • Phone: 510-526-3937
  • Fax: 510-526-6133
Mailing address:
  • Phone: 510-526-3937
  • Fax: 510-526-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36197
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009394
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2696
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: