Provider Demographics
NPI:1154552560
Name:JEFFREY A HALL O D INC
Entity type:Organization
Organization Name:JEFFREY A HALL O D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-464-2076
Mailing Address - Street 1:8312 LAKE MURRAY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3435
Mailing Address - Country:US
Mailing Address - Phone:619-464-2076
Mailing Address - Fax:619-464-8958
Practice Address - Street 1:8312 LAKE MURRAY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3435
Practice Address - Country:US
Practice Address - Phone:619-464-2076
Practice Address - Fax:619-464-8958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6242T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA309AMedicare PIN