Provider Demographics
NPI:1376742130
Name:HAMILTON, TIMOTHY BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BRIAN
Last Name:HAMILTON
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 1:1360 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9066
Mailing Address - Country:US
Mailing Address - Phone:941-480-2135
Mailing Address - Fax:
Practice Address - Street 1:5409 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-2012
Practice Address - Country:US
Practice Address - Phone:941-351-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102134100Medicaid
KY410037033Medicare PIN