Provider Demographics
NPI:1518638287
Name:HAMOUIE, JUDY (OD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HAMOUIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 GLENCOE AVE UNIT 319
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4629
Mailing Address - Country:US
Mailing Address - Phone:312-523-9208
Mailing Address - Fax:
Practice Address - Street 1:8610 S SEPULVEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4009
Practice Address - Country:US
Practice Address - Phone:310-670-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist