Provider Demographics
NPI:1851315626
Name:HAMILTON, DAVID REX (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:REX
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 1:10884 SANTA MONICA BLVD # 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4646
Mailing Address - Country:US
Mailing Address - Phone:424-732-2020
Mailing Address - Fax:424-316-3291
Practice Address - Street 1:10884 SANTA MONICA BLVD # 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4646
Practice Address - Country:US
Practice Address - Phone:424-732-2020
Practice Address - Fax:424-316-3291
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69988207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A699880Medicaid
CAFH530ZMedicare PIN
CAWA69988AMedicare PIN
CA00A699880Medicaid