Healthcare Provider Details

I. General information

NPI: 1619150976
Provider Name (Legal Business Name): DR PATRICIA A. HALLER OPTOMETRIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 W MAIN ST
CHILLICOTHEE OH
45601-3104
US

IV. Provider business mailing address

PO BOX 95
CHILLICOTHEE OH
45601-0095
US

V. Phone/Fax

Practice location:
  • Phone: 740-774-4616
  • Fax: 740-779-3856
Mailing address:
  • Phone: 740-774-4616
  • Fax: 740-779-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4841
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4841
License Number StateOH

VIII. Authorized Official

Name: DR. PATRICIA A HALLER
Title or Position: OWNER
Credential: O.D.
Phone: 740-774-4616