Provider Demographics
NPI:1316939606
Name:HALL, JAMES T (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
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 1:106 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-1563
Mailing Address - Country:US
Mailing Address - Phone:573-223-7615
Mailing Address - Fax:573-223-7867
Practice Address - Street 1:106 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-1563
Practice Address - Country:US
Practice Address - Phone:573-223-7615
Practice Address - Fax:573-223-7867
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU05882Medicare UPIN
MO000006903Medicare ID - Type Unspecified
MO0213120001Medicare NSC