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General NPI Number Information
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NPI Number | 1972562734
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Entity Type | Individual
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Provider Name | PETER EBBERT HALL D.V.M ., O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 1040 BRIGHTON AVE CORNERBROOK PLAZA EYECARE/PORTLAND EYECARE
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City | PORTLAND
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State | ME
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Zip | 04102-1030
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Country | US
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Telephone | 207-253-5333
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Fax | 207-253-5332
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Provider Business Mailing Address
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Address Line | 18 JUSTAMERE RD
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City | FALMOUTH
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State | ME
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Zip | 04105-1912
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Country | US
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Telephone | 207-420-0431
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Fax | 207-253-5332
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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 | ME OPT860
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License Number State | ME
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