Provider Demographics
NPI:1063693596
Name:TAMMY H. HAWKS O.D.
Entity type:Organization
Organization Name:TAMMY H. HAWKS O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-523-1420
Mailing Address - Street 1:2600 E 7TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-4375
Mailing Address - Country:US
Mailing Address - Phone:704-523-1420
Mailing Address - Fax:704-523-6137
Practice Address - Street 1:2600 E 7TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4375
Practice Address - Country:US
Practice Address - Phone:704-523-1420
Practice Address - Fax:704-523-6137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2468419Medicare PIN