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General NPI Number Information
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NPI Number | 1477654549
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Entity Type | Individual
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Provider Name | CINDIJO M HALLQUIST O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 09/23/2018
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Provider Practice Location Address
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Address Line | 9554 S MASON MONTGOMERY RD
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City | MASON
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State | OH
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Zip | 45040-9759
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Country | US
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Telephone | 513-486-0417
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Fax | 513-339-0143
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Provider Business Mailing Address
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Address Line | 726 E MAIN ST STE F289
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City | LEBANON
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State | OH
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Zip | 45036-1900
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Country | US
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Telephone | 513-228-0790
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Fax | 513-228-0790
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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 | 4256-T1271
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License Number State | OH
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