Provider Demographics
NPI:1790858306
Name:HALL, LYLE ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:ARTHUR
Last Name:HALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2200 SO WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-775-3135
Mailing Address - Fax:701-772-8161
Practice Address - Street 1:2200 SO WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-775-3135
Practice Address - Fax:701-772-8161
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND380152W00000X
MN2474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
60240OtherVOCATIONAL REHAB CENTER
92038HAOtherBLUE SHIELD OF MN
NDHAL8822OtherBCBSND
HAL8822OtherBLUE SHIELD OF ND ALTRU
ND60240Medicaid
92038HAOtherMN COMPREHENSIVE CARE
140690OtherU CARE MN
60081OtherND DEPT OF HUMAN
MN92038AOtherBCBSMN
HAL800380OtherVISION SERVICES INC
2208369OtherMEDICA
92038HAOtherBLUE PLUS OF MINNESOTA
NDHAL8822OtherBCBSND
2208369OtherMEDICA
92038HAOtherMN COMPREHENSIVE CARE
HAL800380OtherVISION SERVICES INC