Provider Demographics
NPI:1255577813
Name:RICHARD HALE, OD, INC.
Entity type:Organization
Organization Name:RICHARD HALE, OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-254-1190
Mailing Address - Street 1:106 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-2908
Mailing Address - Country:US
Mailing Address - Phone:812-254-1190
Mailing Address - Fax:812-254-4252
Practice Address - Street 1:106 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2908
Practice Address - Country:US
Practice Address - Phone:812-254-1190
Practice Address - Fax:812-254-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001738B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100089230AMedicaid
IN410046172OtherRAILROAD
IN410046172OtherRAILROAD
INT34597Medicare UPIN
IN0538490001Medicare NSC