Hallberg, Theodore M

Hallberg, Theodore M is an individual health care provider with primary practice located at 3206 Churchland Blvd , Chesapeake VA 23321-5206. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Hallberg, Theodore M can be contacted via phone (757) 484-0101.

Contact Information

Primary practice address
3206 Churchland Blvd Chesapeake VA 23321-5206
Phone: (757) 484-0101
Fax: (757) 484-0515
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 0601002124 Virginia

Profile Details

NPI number 1255331757
LBN Legal business name Hallberg, Theodore M
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2005
Last updated Jul 21st, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255331757 NPPES
Virginia MEDICAID 009235094
Virginia Other 753028236

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