Provider Demographics
NPI:1306803382
Name:HAMPTON, MICHAEL S (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HAMPTON
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 1:355 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-2814
Mailing Address - Country:US
Mailing Address - Phone:215-672-4300
Mailing Address - Fax:217-672-9524
Practice Address - Street 1:355 LINCOLN AVE
Practice Address - Street 2:OPTICAL
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2814
Practice Address - Country:US
Practice Address - Phone:570-424-8728
Practice Address - Fax:570-424-8751
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009153190002Medicaid
PA1009153190002Medicaid
U63865Medicare UPIN