Provider Demographics
NPI:1124087929
Name:HAMM-LAVALLEY, ROBIN ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:ELLEN
Last Name:HAMM-LAVALLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5513
Mailing Address - Country:US
Mailing Address - Phone:740-456-4024
Mailing Address - Fax:740-456-6696
Practice Address - Street 1:4248 GALLIA ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5513
Practice Address - Country:US
Practice Address - Phone:740-456-4024
Practice Address - Fax:740-456-6696
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0846713Medicaid
OHU32453Medicare UPIN
OH1277570001Medicare NSC
OHHA0718412Medicare ID - Type Unspecified