Individual
DR. TOM LAVERN HALL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
136 E GRAND RIVER AVE, FOWLERVILLE, MI 48836
(517) 223-9988
(517) 223-9071
Mailing address
136 E GRAND RIVER AVE, FOWLERVILLE, MI 48836-5136
(517) 223-9988
(517) 223-9071
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004859
MI
152WC0802X
Corneal and Contact Management Optometrist
4901004859
MI
152WP0200X
Pediatric Optometrist
4901004859
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336556893
—
MI
Enumeration date
07/16/2014
Last updated
10/08/2018
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