Provider Demographics
NPI:1902860638
Name:HALL, JEFFREY A (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
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 1:8312 LAKE MURRAY BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119
Mailing Address - Country:US
Mailing Address - Phone:619-697-0481
Mailing Address - Fax:
Practice Address - Street 1:8312 LAKE MURRAY BLVD
Practice Address - Street 2:STE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119
Practice Address - Country:US
Practice Address - Phone:619-697-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6242T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMEDI-CAL SUPPLIEROther81506001
CASD 0062420OtherMEDI-CAL
CASD 0062420OtherMEDI-CAL
CAT70098Medicare UPIN
CAMH0637085OtherDEA