Healthcare Provider Details

I. General information

NPI: 1124087929
Provider Name (Legal Business Name): ROBIN ELLEN HAMM-LAVALLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4248 GALLIA ST
NEW BOSTON OH
45662-5513
US

IV. Provider business mailing address

4248 GALLIA ST
NEW BOSTON OH
45662-5513
US

V. Phone/Fax

Practice location:
  • Phone: 740-456-4024
  • Fax: 740-456-6696
Mailing address:
  • Phone: 740-456-4024
  • Fax: 740-456-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4257
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: