Provider Demographics
NPI:1437124070
Name:HALE, AMANDA N (OD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:HALE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-2978
Mailing Address - Country:US
Mailing Address - Phone:413-442-9421
Mailing Address - Fax:413-443-3115
Practice Address - Street 1:457 DALTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-2978
Practice Address - Country:US
Practice Address - Phone:413-442-9421
Practice Address - Fax:413-443-3115
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001423152W00000X
MA4840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20936Medicare PIN