Provider Demographics
NPI:1982748869
Name:HALL, ROBERT C (LDO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:HALL
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:343 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1644
Mailing Address - Country:US
Mailing Address - Phone:973-366-1181
Mailing Address - Fax:973-366-7866
Practice Address - Street 1:343 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-1644
Practice Address - Country:US
Practice Address - Phone:973-366-1181
Practice Address - Fax:973-366-7866
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-1355156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician