Healthcare Provider Details

I. General information

NPI: 1003513938
Provider Name (Legal Business Name): JON HALL LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 SAWMILL ROAD WALMART VISION CENTER
DUBLIN OH
43016
US

IV. Provider business mailing address

7730 SAWMILL ROAD WALMART VISION CENTER
DUBLIN OH
43016
US

V. Phone/Fax

Practice location:
  • Phone: 614-943-6508
  • Fax:
Mailing address:
  • Phone: 614-943-6508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.013996-SC
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: