Provider Demographics
NPI:1477617926
Name:HAMANN, JOSEPH A
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:HAMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18707 BURNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3588
Mailing Address - Country:US
Mailing Address - Phone:708-474-0404
Mailing Address - Fax:708-895-5245
Practice Address - Street 1:18707 BURNHAM AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3588
Practice Address - Country:US
Practice Address - Phone:708-474-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4049001Medicare PIN
ILP00910051Medicare PIN
IL0659900001Medicare NSC
IL410018531Medicare PIN