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:
Health care specialties
| Specialty | Code | License # | 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 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255331757 | NPPES |
| Virginia | MEDICAID | 009235094 | |
| Virginia | Other | 753028236 |
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