Provider Demographics
NPI:1063640522
Name:HALL, ELI S (OD)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:S
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 1:534 E HYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1955
Mailing Address - Country:US
Mailing Address - Phone:970-925-3020
Mailing Address - Fax:970-925-3198
Practice Address - Street 1:534 E HYMAN AVE
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1955
Practice Address - Country:US
Practice Address - Phone:970-925-3020
Practice Address - Fax:970-925-3198
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2716152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4691Medicare PIN
COCO305638Medicare PIN