Provider Demographics
NPI:1699860007
Name:HALL, HOWARD LEON (OD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:LEON
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 1:701 GILLHAM ST.
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-0778
Mailing Address - Country:US
Mailing Address - Phone:479-394-7771
Mailing Address - Fax:479-394-7770
Practice Address - Street 1:701 GILLHAM AVE
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4137
Practice Address - Country:US
Practice Address - Phone:479-394-7771
Practice Address - Fax:479-394-7770
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102929722Medicaid
AR47943Medicare PIN
ART20146Medicare UPIN