Healthcare Provider Details

I. General information

NPI: 1588727390
Provider Name (Legal Business Name): HOLLY HAMILTON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WOLFRUM RD STE 106
WELDON SPRING MO
63304-7898
US

IV. Provider business mailing address

1120 WOLFRUM RD STE 106
WELDON SPRING MO
63304-7898
US

V. Phone/Fax

Practice location:
  • Phone: 636-447-2244
  • Fax:
Mailing address:
  • Phone: 636-447-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03294
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: