Healthcare Provider Details

I. General information

NPI: 1013967181
Provider Name (Legal Business Name): MICHAEL WAYNE HAMMER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 WAUKEGAN RD SUITE 200
DEERFIELD IL
60015-4342
US

IV. Provider business mailing address

2480 SOCIALVILLE FOSTER RD
MAINEVILLE OH
45039-9305
US

V. Phone/Fax

Practice location:
  • Phone: 800-317-0711
  • Fax: 800-434-7113
Mailing address:
  • Phone: 513-677-3880
  • Fax: 513-677-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3773T58
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: