Provider Demographics
NPI:1972562734
Name:HALL, PETER EBBERT (DVM , OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:EBBERT
Last Name:HALL
Suffix:
Gender:M
Credentials:DVM , OD
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Mailing Address - Street 1:18 JUSTAMERE RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1912
Mailing Address - Country:US
Mailing Address - Phone:207-420-0431
Mailing Address - Fax:207-253-5332
Practice Address - Street 1:1040 BRIGHTON AVE
Practice Address - Street 2:CORNERBROOK PLAZA EYECARE/PORTLAND EYECARE
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1030
Practice Address - Country:US
Practice Address - Phone:207-253-5333
Practice Address - Fax:207-253-5332
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEME OPT860152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist