Provider Demographics
NPI:1669482394
Name:HALL, CHRIS (OD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
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:G3548 FLUSHING RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4255
Mailing Address - Country:US
Mailing Address - Phone:810-733-2020
Mailing Address - Fax:
Practice Address - Street 1:G3548 FLUSHING RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4255
Practice Address - Country:US
Practice Address - Phone:810-733-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI002793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVC250023OtherMCARE
MI382337545OtherVISION SERVICE PLAN
MI900B56581OtherBLUE CROSS BLUE SHIELD
MI1011175OtherMCLAREN HEALTH PLAN
MI1709401Medicaid
MI204947OtherTOTAL HEALTH CARE
MIMI02793OtherVISION BENEFITS OF AMERIC
MIMI2793OtherEYEMED