Provider Demographics
NPI:1588302939
Name:HALE VISION LLC
Entity type:Organization
Organization Name:HALE VISION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LACIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALE CONARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-726-9137
Mailing Address - Street 1:2722 S. MAIN ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-726-9137
Mailing Address - Fax:
Practice Address - Street 1:2722 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2600
Practice Address - Country:US
Practice Address - Phone:417-726-9137
Practice Address - Fax:314-594-2983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty