Provider Demographics
NPI:1164516530
Name:HATHAWAY, JAMES R (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HATHAWAY
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 1:22225 S CAVE BAY RD
Mailing Address - Street 2:
Mailing Address - City:WORLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83876-7788
Mailing Address - Country:US
Mailing Address - Phone:509-954-9856
Mailing Address - Fax:
Practice Address - Street 1:22225 S CAVE BAY RD
Practice Address - Street 2:
Practice Address - City:WORLEY
Practice Address - State:ID
Practice Address - Zip Code:83876-7788
Practice Address - Country:US
Practice Address - Phone:509-954-9856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3479152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist