Provider Demographics
NPI:1639150097
Name:HAMOU, FRED (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:HAMOU
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1049
Mailing Address - Country:US
Mailing Address - Phone:718-231-9000
Mailing Address - Fax:718-405-9626
Practice Address - Street 1:3409 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1049
Practice Address - Country:US
Practice Address - Phone:718-231-9000
Practice Address - Fax:718-405-9626
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3419156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00327000Medicaid