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NPI Code Detail

MEDICARE: DR. ANSELM P HALL OPTOMETRIST

MEDICARE: DR. ANSELM P HALL OPTOMETRIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist11884TCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111884TOTHERCASTATE LICENSE

General Provider Information

NPI Number : 1679642243
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANSELM P HALL OPTOMETRIST
Provider Business Mailing Address
First Line : 950 S GRAND AVE FL 2
Second Line :
City : LOS ANGELES
State : CA
Zip : 90015-3999
Country : US
Telephone Number : 323-669-4346
Fax Number :
Provider Business Practice Location Address
First Line : 4618 FOUNTAIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90029-1977
Country : US
Telephone Number : 323-953-7191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 02/25/2020

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Directions to “ DR. ANSELM P HALL OPTOMETRIST” Practice Location

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