Provider Demographics
NPI:1306934823
Name:HAMILTON, TODD (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:HAMILTON
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 1:1120 WOLFRUM RD
Mailing Address - Street 2:STE. 106
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7898
Mailing Address - Country:US
Mailing Address - Phone:636-447-2244
Mailing Address - Fax:636-447-2213
Practice Address - Street 1:1120 WOLFRUM RD
Practice Address - Street 2:STE. 106
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-7898
Practice Address - Country:US
Practice Address - Phone:636-447-2244
Practice Address - Fax:636-447-2213
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1595019Medicare PIN
MO151119Medicare UPIN