Individual provider Active NPI

David Keith Hall, O.D.

  • Optometrist
  • Okmulgee, OK
National Provider Identifier
1740296888
Registry record updated Nov 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2190 Issued in OK
Practice address
300 Creek PL
Okmulgee, OK 74447-6730
Phone
(918) 756-0316
Fax
(918) 756-2022
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2190 OK Primary

Addresses

Primary practice location

300 Creek PL
Okmulgee, OK 74447-6730

Mailing address

PO Box 520
300 Creek Place
Okmulgee, OK 74447-0520
Phone (918) 756-0316

Other identifiers 1

IdentifierTypeStateIssuer
100767610AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200706001038 TN Practitioner - Optometry 7416066717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern College of OptometryGroup PAC ID 4587550454, 57 clinicians

Practice addresses (Care Compare)

1245 Madison Ave
Memphis, TN 38104-2211
Phone (901) 722-3385

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2190OKMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern College of Optometry Optometrist CurrentSince Jun 25, 2020 Accepting new patients

Locations

1245 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250

1225 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250

1350 Concourse Ave
Ste 264
Memphis, TN 38104
Phone (901) 252-3670

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290988800000",
    "number": "1740296888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520",
            "address_2": "300 CREEK PLACE",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744470520",
            "telephone_number": "918-756-0316",
            "fax_number": "918-756-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CREEK PL",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744476730",
            "telephone_number": "918-756-0316",
            "fax_number": "918-756-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "DAVID",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2010-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100767610A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Okmulgee, OK

Sources for this page

Verify at the official NPI Registry.