Provider Demographics
NPI:1154468676
Name:HAMER, JONATHAN DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:HAMER
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 1:23353 PORTAGE WAY
Mailing Address - Street 2:#2307
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5401
Mailing Address - Country:US
Mailing Address - Phone:248-946-4291
Mailing Address - Fax:
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1902
Practice Address - Country:US
Practice Address - Phone:734-665-5306
Practice Address - Fax:734-930-2383
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004354152W00000X
SC1247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1154468676Medicaid
JH004354OtherBCBS MICHIGAN
JH004354OtherBCBS MICHIGAN
MI1154468676Medicaid