Provider Demographics
NPI:1366424517
Name:HALL, GEORGE LOUIS JR (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LOUIS
Last Name:HALL
Suffix:JR
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 1:18040 SATURN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-4500
Mailing Address - Country:US
Mailing Address - Phone:281-333-8600
Mailing Address - Fax:281-333-4800
Practice Address - Street 1:18040 SATURN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-4500
Practice Address - Country:US
Practice Address - Phone:281-333-8600
Practice Address - Fax:281-333-4800
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2091TG152W00000X
TX2091T152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148276204Medicaid
TXT13633Medicare UPIN
TXTXB119371Medicare PIN
TX870705316OtherTAX ID NUMBER
TXT13633Medicare UPIN