Provider Demographics
NPI:1497730477
Name:HALE, LEALIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:LEALIS
Middle Name:L
Last Name:HALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:OPHTHALMOLOGY DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8233
Mailing Address - Fax:850-863-1127
Practice Address - Street 1:1005 MAR WALT DR
Practice Address - Street 2:OPHTHALMOLOGY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6707
Practice Address - Country:US
Practice Address - Phone:850-863-8233
Practice Address - Fax:850-863-1127
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME82426207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D58368Medicare UPIN
FL58957ZMedicare ID - Type Unspecified