Provider Demographics
NPI:1477818631
Name:HAL C HERRING JR OD PA
Entity type:Organization
Organization Name:HAL C HERRING JR OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:910-628-8316
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-0648
Mailing Address - Country:US
Mailing Address - Phone:910-628-8316
Mailing Address - Fax:910-628-5642
Practice Address - Street 1:204 IONA ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-1616
Practice Address - Country:US
Practice Address - Phone:910-628-8316
Practice Address - Fax:910-628-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0353030001OtherDMERC
NC410043066OtherUNITED HEALTHCARE RAILROAD MEDICARE
NC8909378Medicaid
NC410043066OtherUNITED HEALTHCARE RAILROAD MEDICARE
NC8909378Medicaid