Provider Demographics
NPI:1295760767
Name:W. BRENT HALL, O.D. P.A.
Entity type:Organization
Organization Name:W. BRENT HALL, O.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-541-2020
Mailing Address - Street 1:3001 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-4802
Mailing Address - Country:US
Mailing Address - Phone:870-541-2020
Mailing Address - Fax:870-536-0358
Practice Address - Street 1:3001 W 28TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-4802
Practice Address - Country:US
Practice Address - Phone:870-541-2020
Practice Address - Fax:870-536-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158851722Medicaid
AR0379260001Medicare NSC
AR158851722Medicaid
AR5C924Medicare ID - Type Unspecified