MEDICARE: J.A. HALL, O.D., P.A.

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
1	152W00000X	Optometrist	6587TG	TX

General Provider Information

NPI Number	:	1780801415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.A. HALL, O.D., P.A.

Provider Business Mailing Address
First Line	:	2901 ALTA MERE DR
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4100
Country	:	US
Telephone Number	:	817-735-9000
Fax Number	:	817-735-9074

Provider Business Practice Location Address
First Line	:	2901 ALTA MERE DR
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4100
Country	:	US
Telephone Number	:	817-735-9000
Fax Number	:	817-735-9074

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES AARON HALL
Credential	:	OD
Telephone Number	:	817-735-9000

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	01/11/2008

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