1336593847 NPI number — DR. SAMANTHA HALVORSEN BSC, OD

Table of content: DR. SAMANTHA HALVORSEN BSC, OD (NPI 1336593847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336593847 NPI number — DR. SAMANTHA HALVORSEN BSC, OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALVORSEN
Provider First Name:
SAMANTHA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
BSC, OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336593847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6214 45 AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMROSE
Provider Business Mailing Address State Name:
ALBERTA
Provider Business Mailing Address Postal Code:
T4V 0C2
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
787-222-1414
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1851 SIROCCO DR SW
Provider Second Line Business Practice Location Address:
UNIT 505
Provider Business Practice Location Address City Name:
CALGARY
Provider Business Practice Location Address State Name:
ALBERTA
Provider Business Practice Location Address Postal Code:
T3H4R5
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
403-685-4447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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