Provider Demographics
NPI:1992767081
Name:HALL, MICHELLE L (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3770 CARMAN RD, CARMAN PLAZA
Mailing Address - Street 2:#6B
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303
Mailing Address - Country:US
Mailing Address - Phone:518-982-0123
Mailing Address - Fax:518-982-0124
Practice Address - Street 1:3770 CARMAN RD, CARMAN PLAZA
Practice Address - Street 2:#6B
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303
Practice Address - Country:US
Practice Address - Phone:518-982-0123
Practice Address - Fax:518-982-0124
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005806-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU64197Medicare UPIN