Provider Demographics
NPI:1477654549
Name:HALLQUIST, CINDIJO M (OD)
Entity Type:Individual
Prefix:DR
First Name:CINDIJO
Middle Name:M
Last Name:HALLQUIST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:CINDIJO
Other - Middle Name:HALLQUIST
Other - Last Name:CARAFICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:726 E MAIN ST STE F289
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1900
Mailing Address - Country:US
Mailing Address - Phone:513-228-0790
Mailing Address - Fax:513-228-0790
Practice Address - Street 1:9554 S MASON MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9759
Practice Address - Country:US
Practice Address - Phone:513-486-0417
Practice Address - Fax:513-339-0143
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4256-T1271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U07966Medicare UPIN