Individual
MR. THEODORE M HALLBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3206 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5206
(757) 484-0101
(757) 484-0515
Mailing address
3206 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5206
(757) 484-0101
(757) 484-0515
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0601002124
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009235094
—
VA
01
—
753028236
TAX ID#
VA
Enumeration date
07/26/2005
Last updated
07/21/2010
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