Individual
MR. THEODORE M HALLBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
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
Update your record
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