Provider Demographics
NPI:1114026606
Name:HAMERL, BRUCE (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:HAMERL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3384 S COLERIDGE PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5584
Mailing Address - Country:US
Mailing Address - Phone:208-385-7958
Mailing Address - Fax:
Practice Address - Street 1:8300 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1639
Practice Address - Country:US
Practice Address - Phone:208-321-9082
Practice Address - Fax:208-321-9179
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1592561Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IDU52756Medicare UPIN