Provider Demographics
NPI:1700994100
Name:HALLINAN, DENNIS MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:HALLINAN
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 1:1121 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3006
Mailing Address - Country:US
Mailing Address - Phone:814-943-4997
Mailing Address - Fax:
Practice Address - Street 1:6716 TOWNE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-6933
Practice Address - Country:US
Practice Address - Phone:814-644-6926
Practice Address - Fax:814-644-6928
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101459491 0001Medicaid
PAP00739258Medicare PIN
PA101459491 0001Medicaid
PAV03101Medicare UPIN