Provider Demographics
NPI:1790829059
Name:BALL, DONALD A (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:BALL
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 1:4237 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2259
Mailing Address - Country:US
Mailing Address - Phone:248-626-3964
Mailing Address - Fax:
Practice Address - Street 1:500 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4205
Practice Address - Country:US
Practice Address - Phone:248-597-2956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist