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General NPI Number Information
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NPI Number | 1346273877
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Entity Type | Organization
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Legal Business Name | HAL W BREEDLOVE OD PC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 1729 WILDWOOD DR SUITE 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3176
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Country | US
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Telephone | 757-426-2020
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Fax | 757-481-1964
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Provider Business Mailing Address
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Address Line | 1729 WILDWOOD DRIVE SUITE 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-426-2020
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Fax | 757-481-1964
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. HAL W BREEDLOVE
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Credential | OD
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Telephone | 757-426-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618000633
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License Number State |
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