Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OH4459 | OH |
NPI | 1003868571 |
---|---|
Provider Name | Wendy Sue Hallier |
First Address | Galena, OH 43021-9240 |
Second Address | Reynoldsburg, OH 43068-8024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 10/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2178647 | (05) | OH |
U43370 | (02) | OH |