Provider Demographics
NPI:1407919830
Name:WALL & HAMILTON OPTOMETRISTS SC
Entity Type:Organization
Organization Name:WALL & HAMILTON OPTOMETRISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-452-5213
Mailing Address - Street 1:1337 N TAYLOR DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3012
Mailing Address - Country:US
Mailing Address - Phone:920-452-5213
Mailing Address - Fax:920-452-6750
Practice Address - Street 1:1337 N TAYLOR DR STE 202
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3012
Practice Address - Country:US
Practice Address - Phone:920-452-5213
Practice Address - Fax:920-452-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326OtherSTATE DR WAYNE WALL
WI1528127180OtherNPI DR SANDRA HAMILTON
WI38596800Medicaid
WI1154498574OtherNPI DR WAYNE WALL
WI38566900Medicaid
WI2592OtherSTATE DR SANDRA HAMILTO
WIT13648Medicare UPIN
WI47122Medicare ID - Type UnspecifiedDR. SANDRA J HAMILTON
WI87548Medicare ID - Type UnspecifiedDR. WAYNE E WALL
WI1326OtherSTATE DR WAYNE WALL