Provider Demographics
NPI:1043229669
Name:RICHARD D HAMILTON OD PA
Entity Type:Organization
Organization Name:RICHARD D HAMILTON OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-385-4444
Mailing Address - Street 1:2724 CAPITAL CIR NE
Mailing Address - Street 2:#1
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1118
Mailing Address - Country:US
Mailing Address - Phone:850-385-4444
Mailing Address - Fax:850-386-5383
Practice Address - Street 1:2724 CAPITAL CIR NE
Practice Address - Street 2:#1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4108
Practice Address - Country:US
Practice Address - Phone:850-385-4444
Practice Address - Fax:850-386-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39750Medicare ID - Type UnspecifiedMCR GROUP NUMBER
0415950001Medicare NSC