William R Hall, OD
Individual provider Active NPI Optometrist · Bloomfield, NM
NPI 1023171691 · NPPES record last updated Sep 26, 2012
Key facts
- NPI
- 1023171691
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 471 (NM)
- Practice address
- 702 W Broadway Ave
Bloomfield, NM 87413-5705 - Phone
- (505) 632-8088
- Fax
- (505) 632-3805
- NPI assigned
- Dec 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 471 | NM | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 471 | NM | Yes |
Addresses
Primary practice location
702 W Broadway Ave
Bloomfield, NM 87413-5705
Mailing address
702 W Broadway Ave
Bloomfield, NM 87413-5705
Phone (505) 632-8088
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000Q5854 | Medicaid | NM |
Other providers in Bloomfield, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.