Provider Demographics
NPI:1578582037
Name:HAMILTON, DEREK EVAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:EVAN
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 1:15300 VALDERRAMA CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3846
Mailing Address - Country:US
Mailing Address - Phone:248-701-2787
Mailing Address - Fax:
Practice Address - Street 1:15550 RR 620 N STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5206
Practice Address - Country:US
Practice Address - Phone:512-251-4040
Practice Address - Fax:512-252-1562
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6931T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist