Provider Demographics
NPI:1255699658
Name:TODD HALL OD PA
Entity type:Organization
Organization Name:TODD HALL OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-453-5400
Mailing Address - Street 1:814 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2825
Mailing Address - Country:US
Mailing Address - Phone:662-453-5400
Mailing Address - Fax:662-453-5726
Practice Address - Street 1:814 W PARK AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2825
Practice Address - Country:US
Practice Address - Phone:662-453-5400
Practice Address - Fax:662-453-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880003Medicaid
MS410023650OtherPALMETTO GBA RAILROAD MEDICARE
MS00880003Medicaid
MS410000080Medicare PIN