Provider Demographics
NPI:1245892785
Name:HAMM, KATHRYN JANE (OD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:JANE
Last Name:HAMM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:HAMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1010 N RIDGE RD APT 1517
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6075
Mailing Address - Country:US
Mailing Address - Phone:913-633-0803
Mailing Address - Fax:
Practice Address - Street 1:1400 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2201
Practice Address - Country:US
Practice Address - Phone:316-320-2200
Practice Address - Fax:316-320-0430
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty