Provider Demographics
NPI:1053312181
Name:HERRING, HAL C JR (OD, PA)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:C
Last Name:HERRING
Suffix:JR
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:HAL
Other - Middle Name:C
Other - Last Name:HERRING
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:OD, PA
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-0648
Mailing Address - Country:US
Mailing Address - Phone:910-628-8316
Mailing Address - Fax:910-628-5642
Practice Address - Street 1:204 IONA ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-1616
Practice Address - Country:US
Practice Address - Phone:910-628-8316
Practice Address - Fax:910-628-5642
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410043066OtherRR MEDICARE
NC8909378Medicaid
410043066OtherUNITED HEALTHCARE
0353030001Medicare NSC
246361AMedicare PIN
410043066OtherUNITED HEALTHCARE