Provider Demographics
NPI:1235312455
Name:HAMILTON FAMILY EYECARE, PC
Entity Type:Organization
Organization Name:HAMILTON FAMILY EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:269-751-4400
Mailing Address - Street 1:3426 M-40 HWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9512
Mailing Address - Country:US
Mailing Address - Phone:269-751-4400
Mailing Address - Fax:
Practice Address - Street 1:3426 M-40 HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419-9512
Practice Address - Country:US
Practice Address - Phone:269-751-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003563261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900Z310280OtherBLUE SHEILD
MI7000077251OtherPRIORITY HEALTH MEDICAID
MI7000077251OtherPRIORITY HEALTH MEDICAID
MIU31656Medicare UPIN
MI900Z310280OtherBLUE SHEILD