Provider Demographics
NPI:1457390080
Name:HALL, WILLIAM BRENT (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRENT
Last Name:HALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:BRENT
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR15642000041OtherQUAL CHOISE
AR410014834OtherPALMETTO-GBA-RAILROAD MED
AR117893722Medicaid
AR2220012OtherUNITED HEATHCARE
AR5954657OtherAETNA
AR0379260001OtherPALMETTO
AR5954657OtherAETNA
ARU00882Medicare UPIN