Provider Demographics
NPI:1952318156
Name:HALL, KENT K (OD)
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:K
Last Name:HALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 PENNSYLVANIA AVE
Mailing Address - Street 2:WHITTINGTON & WHITTINGTON
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302
Mailing Address - Country:US
Mailing Address - Phone:304-342-0660
Mailing Address - Fax:304-344-5483
Practice Address - Street 1:3840 PENNSYLVANIA AVE
Practice Address - Street 2:WHITTINGTON & WHITTINGTON
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-342-0660
Practice Address - Fax:304-344-5483
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV816D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V06177Medicare UPIN
WVHA4166091Medicare ID - Type Unspecified
WV0316310001Medicare PIN