Provider Demographics
NPI:1215903125
Name:HALE, JAMES ROSS (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROSS
Last Name:HALE
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 1:1505 NW HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5816
Mailing Address - Country:US
Mailing Address - Phone:541-754-6222
Mailing Address - Fax:541-757-2055
Practice Address - Street 1:1505 NW HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5816
Practice Address - Country:US
Practice Address - Phone:541-754-6222
Practice Address - Fax:541-757-2055
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2674ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU85643Medicare UPIN
OR132649Medicare PIN