Healthcare Provider Details

I. General information

NPI: 1902860638
Provider Name (Legal Business Name): JEFFREY A HALL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8312 LAKE MURRAY BLVD STE C
SAN DIEGO CA
92119
US

IV. Provider business mailing address

8312 LAKE MURRAY BLVD STE C
SAN DIEGO CA
92119
US

V. Phone/Fax

Practice location:
  • Phone: 619-697-0481
  • Fax:
Mailing address:
  • Phone: 619-697-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6242T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: