Provider Demographics
NPI:1720822943
Name:HALE, TRENTON (ABOC)
Entity type:Individual
Prefix:
First Name:TRENTON
Middle Name:
Last Name:HALE
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 E CEDAR AVE APT E
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2706
Mailing Address - Country:US
Mailing Address - Phone:816-787-8137
Mailing Address - Fax:
Practice Address - Street 1:26471 CARL BOYER DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2996
Practice Address - Country:US
Practice Address - Phone:816-787-8137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42300156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician