Provider Demographics
NPI:1699855668
Name:HAMM, WAYNE F (OD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:F
Last Name:HAMM
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 1:1811 N DAL PASO ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-3042
Mailing Address - Country:US
Mailing Address - Phone:575-397-3611
Mailing Address - Fax:575-393-1544
Practice Address - Street 1:1811 N DAL PASO ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-3042
Practice Address - Country:US
Practice Address - Phone:575-397-3611
Practice Address - Fax:575-393-1544
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00P198OtherBCBS OF NEW MEXICO
NM2590859Medicare ID - Type Unspecified
NMT75012Medicare UPIN