MEDICARE: DR. ANITA H. HALL VINCENT O.D.

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	4478T	TX

General Provider Information

NPI Number	:	1811020928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA H. HALL VINCENT O.D.

Provider Business Mailing Address
First Line	:	8351 ANDERSON BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76120-3625
Country	:	US
Telephone Number	:	817-801-3202
Fax Number	:

Provider Business Practice Location Address
First Line	:	8351 ANDERSON BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76120-3625
Country	:	US
Telephone Number	:	817-801-3203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	01/07/2013

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