Provider Demographics
NPI:1477229979
Name:HALL, KYLE ERYN (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ERYN
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:BG CRAWFORD F. SAMS HEALTH CLINIC
Mailing Address - Street 2:UNIT 45011
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96343
Mailing Address - Country:US
Mailing Address - Phone:315-263-4240
Mailing Address - Fax:
Practice Address - Street 1:BG CRAWFORD F. SAMS HEALTH CLINIC
Practice Address - Street 2:UNIT 45011
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96343
Practice Address - Country:US
Practice Address - Phone:315-263-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10311TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist