Provider Demographics
NPI:1477229979
Name:HALL, KYLE ERYN (OD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ERYN
Last Name:HALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 LOVING PATH
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-3303
Mailing Address - Country:US
Mailing Address - Phone:210-394-1188
Mailing Address - Fax:
Practice Address - Street 1:GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL (GLWACH)
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:65584
Practice Address - Country:US
Practice Address - Phone:573-596-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10311T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist