Individual
DR. ANSELM P HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTOMETRIST
Contact information
Practice address
4618 FOUNTAIN AVE, LOS ANGELES, CA 90029-1977
(323) 953-7191
Mailing address
950 S GRAND AVE FL 2, LOS ANGELES, CA 90015-3999
(323) 669-4346
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11884T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11884T
STATE LICENSE
CA
Enumeration date
11/07/2006
Last updated
02/25/2020
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