Healthcare Provider Details

I. General information

NPI: 1003868571
Provider Name (Legal Business Name): WENDY SUE HALLIER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35901 CHESTER RD
AVON OH
44011-1005
US

IV. Provider business mailing address

667 CANTER CT
AVON LAKE OH
44012-4026
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-4765
  • Fax:
Mailing address:
  • Phone: 740-816-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOH4459
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: