Provider Demographics
NPI:1972666782
Name:HAMILL, DIANE P (OD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:P
Last Name:HAMILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:P
Other - Last Name:REDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1012 LOUGHBOROUGH COMMONS
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111
Mailing Address - Country:US
Mailing Address - Phone:314-797-5413
Mailing Address - Fax:314-797-5432
Practice Address - Street 1:1012 LOUGHBOROUGH COMMONS
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111
Practice Address - Country:US
Practice Address - Phone:314-797-5413
Practice Address - Fax:314-797-5432
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02756152W00000X, 152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42811Medicare UPIN