Provider Demographics
NPI:1942409883
Name:HALE, BRIAN JAMES (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:HALE
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 1:1807 TAFT HWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-3528
Mailing Address - Country:US
Mailing Address - Phone:423-886-7252
Mailing Address - Fax:423-886-9551
Practice Address - Street 1:1807 TAFT HWY
Practice Address - Street 2:SUITE 9
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-3528
Practice Address - Country:US
Practice Address - Phone:423-886-7252
Practice Address - Fax:423-886-9551
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN2768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00853314Medicare PIN