Provider Demographics
NPI:1629061502
Name:HALL, ALLISON NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:NICOLE
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 1:1 COLONIAL SQ
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3633
Mailing Address - Country:US
Mailing Address - Phone:479-702-2022
Mailing Address - Fax:479-705-2023
Practice Address - Street 1:1 COLONIAL SQ
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3633
Practice Address - Country:US
Practice Address - Phone:479-702-2022
Practice Address - Fax:479-705-2023
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2537152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150351722Medicaid
AR152665722Medicaid
AR150351722Medicaid
ARU96477Medicare UPIN
AR5F095Medicare ID - Type UnspecifiedCLINIC