Provider Demographics
NPI:1386701530
Name:HALL, DAVID KENNETH (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KENNETH
Last Name:HALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1057 CALLANDER WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6100
Mailing Address - Country:US
Mailing Address - Phone:916-984-0143
Mailing Address - Fax:
Practice Address - Street 1:2155 IRON POINT RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8707
Practice Address - Country:US
Practice Address - Phone:916-817-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist