Provider Demographics
NPI:1558395137
Name:HAMILTON, KEVIN CHARLES (OD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHARLES
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 1:610 REMBRANDT CIR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-9505
Mailing Address - Country:US
Mailing Address - Phone:412-734-2529
Mailing Address - Fax:
Practice Address - Street 1:12280 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-1820
Practice Address - Country:US
Practice Address - Phone:724-863-2000
Practice Address - Fax:724-863-3599
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018114620001Medicaid
PA077290SKLMedicare PIN
PAU99074Medicare UPIN