Provider Demographics
NPI:1922004258
Name:HALL, CAROLYN W (OD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:W
Last Name:HALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 W 14TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3751
Mailing Address - Country:US
Mailing Address - Phone:812-284-0660
Mailing Address - Fax:812-284-3822
Practice Address - Street 1:302 W 14TH ST
Practice Address - Street 2:STE 100
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3751
Practice Address - Country:US
Practice Address - Phone:812-284-0660
Practice Address - Fax:812-284-3822
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002631A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
351995025OtherCIGNA
000000042713OtherANTHEM
4557632OtherAETNA
246589POtherSIHO
IN100381360Medicaid
4557632OtherFIRST HEALTH
1086829OtherPASSPORT
351995025OtherUNITED HEALTHCARE
351995025OtherSAGAMORE
KY77340412OtherUNISYS
918484OtherBLOCK VISION
351995025OtherHUMANA