Provider Demographics
NPI:1699963181
Name:HAMILTON, RODDY T (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:RODDY
Middle Name:T
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 W CUTHBERT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3819
Mailing Address - Country:US
Mailing Address - Phone:432-694-4300
Mailing Address - Fax:432-520-8460
Practice Address - Street 1:2703 W CUTHBERT AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3819
Practice Address - Country:US
Practice Address - Phone:432-694-4300
Practice Address - Fax:432-520-8460
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0691340001Medicare PIN