Provider Demographics
NPI:1689627341
Name:HALL, DENA C (OD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:C
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 1:12 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1720
Mailing Address - Country:US
Mailing Address - Phone:401-949-1616
Mailing Address - Fax:401-949-4251
Practice Address - Street 1:12 SMITH AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1720
Practice Address - Country:US
Practice Address - Phone:401-949-1616
Practice Address - Fax:401-949-4251
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00452152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7004511Medicaid
RI7004511Medicaid