Provider Demographics
NPI:1801001979
Name:BRUCE W HAMERL O D P C
Entity Type:Organization
Organization Name:BRUCE W HAMERL O D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMERL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-321-9082
Mailing Address - Street 1:3384 S COLERIDGE PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5584
Mailing Address - Country:US
Mailing Address - Phone:208-321-9082
Mailing Address - Fax:208-321-9179
Practice Address - Street 1:8300 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1639
Practice Address - Country:US
Practice Address - Phone:208-321-9082
Practice Address - Fax:208-321-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty