Provider Demographics
NPI:1104863448
Name:HAMMAR, JOANNE M (OD)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:M
Last Name:HAMMAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1635
Mailing Address - Country:US
Mailing Address - Phone:541-756-5712
Mailing Address - Fax:541-756-9753
Practice Address - Street 1:2520 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1634
Practice Address - Country:US
Practice Address - Phone:541-756-5712
Practice Address - Fax:541-756-9753
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1638ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0885700001OtherDME ID #
OR1633-1Medicaid
ORT67688Medicare UPIN
OR0885700001OtherDME ID #