=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073509675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES R HALL O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2005
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 W LANCASTER AVE
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19003-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-642-2151
-----------------------------------------------------
Fax | 610-642-2190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 W LANCASTER AVE
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19003-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-642-2151
-----------------------------------------------------
Fax | 610-642-2190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG001134
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------