Provider Demographics
NPI:1588768501
Name:HALL, MICHELE MARIE (OD)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:MARIE
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:12100 SE STEVENS CT
Mailing Address - Street 2:STE 106
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12100 SE STEVENS CT
Practice Address - Street 2:STE 106
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-8707
Practice Address - Country:US
Practice Address - Phone:503-653-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2744T152W00000X
WAOD00003522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist