Provider Demographics
NPI:1639922230
Name:HALL, VALENE TERESA RUTH (ABO CERTIFIED)
Entity type:Individual
Prefix:
First Name:VALENE
Middle Name:TERESA RUTH
Last Name:HALL
Suffix:
Gender:F
Credentials:ABO CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 GRAYWOLF RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5178
Mailing Address - Country:US
Mailing Address - Phone:530-788-8447
Mailing Address - Fax:
Practice Address - Street 1:1601 W STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8651
Practice Address - Country:US
Practice Address - Phone:817-416-8406
Practice Address - Fax:817-416-8419
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician