Provider Demographics
NPI:1336236306
Name:HALL, BENJAMIN A (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:A
Last Name:HALL
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:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-0027
Mailing Address - Country:US
Mailing Address - Phone:270-767-9300
Mailing Address - Fax:270-761-4706
Practice Address - Street 1:312 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-1916
Practice Address - Country:US
Practice Address - Phone:270-767-9300
Practice Address - Fax:270-761-4706
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1261DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01204985OtherRAILROAD MEDICARE PTAN
KY6706600001OtherMEDICARE DME PTAN
KY9356501Medicare ID - Type Unspecified
KYP01204985OtherRAILROAD MEDICARE PTAN