Provider Demographics
NPI:1720421837
Name:HAMON, VIVIAN L
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:L
Last Name:HAMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N KERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-7062
Mailing Address - Country:US
Mailing Address - Phone:918-756-2343
Mailing Address - Fax:918-756-2430
Practice Address - Street 1:1215 N KERN AVE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-7062
Practice Address - Country:US
Practice Address - Phone:918-756-2343
Practice Address - Fax:918-756-2430
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK27-5120266OtherEIN