Provider Demographics
NPI:1760155832
Name:HALE, GARY W (RPSGT, CCSH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:HALE
Suffix:
Gender:M
Credentials:RPSGT, CCSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 AIRPORT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8649
Mailing Address - Country:US
Mailing Address - Phone:850-910-3964
Mailing Address - Fax:
Practice Address - Street 1:1110 AIRPORT BLVD STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8649
Practice Address - Country:US
Practice Address - Phone:251-510-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1160156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist