Provider Demographics
NPI:1316082902
Name:HALE, RICHARD E (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
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 1:106 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-2908
Mailing Address - Country:US
Mailing Address - Phone:812-254-1190
Mailing Address - Fax:812-254-4252
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2908
Practice Address - Country:US
Practice Address - Phone:812-254-1190
Practice Address - Fax:812-254-4252
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001738B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100089230AMedicaid
IN410046172OtherRR MEDICARE
IN160750Medicare PIN
IN410046172OtherRR MEDICARE
IN0538490001Medicare NSC