Provider Demographics
NPI:1528233160
Name:ROBIN E HAMM-LAVALLEY O. D.
Entity Type:Organization
Organization Name:ROBIN E HAMM-LAVALLEY O. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HAMM-LAVALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-456-4024
Mailing Address - Street 1:4248 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5513
Mailing Address - Country:US
Mailing Address - Phone:740-456-4024
Mailing Address - Fax:
Practice Address - Street 1:4248 GALLIA ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5513
Practice Address - Country:US
Practice Address - Phone:740-456-4024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4257332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0846713Medicaid
HA0718412Medicare PIN
U32453Medicare UPIN
1277570001Medicare NSC