Provider Demographics
NPI:1356596860
Name:CHRIS E HALL OD PC
Entity type:Organization
Organization Name:CHRIS E HALL OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DROOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-733-2020
Mailing Address - Street 1:G3548 FLUSHING RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4255
Mailing Address - Country:US
Mailing Address - Phone:810-733-2020
Mailing Address - Fax:810-733-5980
Practice Address - Street 1:G3548 FLUSHING RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4255
Practice Address - Country:US
Practice Address - Phone:810-733-2020
Practice Address - Fax:810-733-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI002793332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI94-1709401Medicaid
MI1060730001Medicare NSC