Provider Demographics
NPI:1497489579
Name:HALL, TAYLOR LEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:LEIGH
Last Name:HALL
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 1:120 OLSON DR STE 107
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2961
Mailing Address - Country:US
Mailing Address - Phone:402-504-4257
Mailing Address - Fax:
Practice Address - Street 1:120 OLSON DR STE 107
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2961
Practice Address - Country:US
Practice Address - Phone:402-504-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist