Provider Demographics
NPI:1053040386
Name:HALL, RUTH NADINE
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:NADINE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 US HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-6106
Mailing Address - Country:US
Mailing Address - Phone:270-449-3005
Mailing Address - Fax:270-365-7538
Practice Address - Street 1:1500 US HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-6106
Practice Address - Country:US
Practice Address - Phone:270-449-3005
Practice Address - Fax:270-365-7538
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111908156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician