Provider Demographics
NPI:1437941895
Name:HALL, BRYANNA (OD)
Entity type:Individual
Prefix:
First Name:BRYANNA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 NEW LONDON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-1313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 PATRIOT DR STE E
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-8951
Practice Address - Country:US
Practice Address - Phone:440-647-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHOPT.007394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program