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General NPI Number Information
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NPI Number | 1417946740
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Entity Type | Individual
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Provider Name | PATRICIA A HALLER O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 59 W MAIN ST
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-3104
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Country | US
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Telephone | 740-774-4616
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Fax | 740-779-3856
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Provider Business Mailing Address
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Address Line | 64 EXECUTIVE CENTER DR
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-8087
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Country | US
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Telephone | 740-774-4616
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Fax | 740-779-3856
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4841
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License Number State | OH
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