Provider Demographics
NPI:1801995386
Name:HAWKE, JAMES E (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:HAWKE
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 1:701 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-6609
Mailing Address - Country:US
Mailing Address - Phone:419-243-3159
Mailing Address - Fax:419-241-5956
Practice Address - Street 1:701 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-6609
Practice Address - Country:US
Practice Address - Phone:419-243-3159
Practice Address - Fax:419-241-5956
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3763152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
03284OtherPARAMOUNT
OH0560245Medicaid
OH0589240001Medicare NSC
HA0552291Medicare ID - Type Unspecified
03284OtherPARAMOUNT