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General NPI Number Information
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NPI Number | 1407919830
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Entity Type | Organization
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Legal Business Name | WALL & HAMILTON OPTOMETRISTS SC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1337 N TAYLOR DR STE 202
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3012
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Country | US
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Telephone | 920-452-5213
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Fax | 920-452-6750
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Provider Business Mailing Address
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Address Line | 1337 N TAYLOR DR STE 202
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3012
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Country | US
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Telephone | 920-452-5213
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Fax | 920-452-6750
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. SANDRA J HAMILTON
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Credential | OD
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Telephone | 920-452-5213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2592
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License Number State | WI
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