Provider Demographics
NPI:1215020615
Name:HALL, ANTHONY BERNARD (PHD OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BERNARD
Last Name:HALL
Suffix:
Gender:M
Credentials:PHD OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 LUDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3828
Mailing Address - Country:US
Mailing Address - Phone:906-786-6573
Mailing Address - Fax:906-786-1174
Practice Address - Street 1:814 LUDINGTON ST
Practice Address - Street 2:FAMILY EYE CARE
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3828
Practice Address - Country:US
Practice Address - Phone:906-786-6573
Practice Address - Fax:906-786-1174
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B110450OtherBLUE CROSS
MI4074414Medicaid
MI4074414Medicaid
MI1249680001Medicare NSC
MIM21960001Medicare PIN
MI410039010Medicare PIN
MIMH1005760OtherDEA