Healthcare Provider Details

I. General information

NPI: 1588618433
Provider Name (Legal Business Name): RONALD J HALL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SMITH AVE
GREENVILLE RI
02828-1720
US

IV. Provider business mailing address

12 SMITH AVE
GREENVILLE RI
02828-1720
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-1616
  • Fax: 401-949-4251
Mailing address:
  • Phone: 401-949-1616
  • Fax: 401-949-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00311
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: