Healthcare Provider Details

I. General information

NPI: 1063419596
Provider Name (Legal Business Name): DONALD A. HALL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

800 N GREEN RIVER RD
EVANSVILLE IN
47715-2471
US

IV. Provider business mailing address

800 N GREEN RIVER RD
EVANSVILLE IN
47715-2471
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-4356
  • Fax: 812-477-4381
Mailing address:
  • Phone: 812-477-4356
  • Fax: 812-477-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001463
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: