Basic Information
| Provider Information | |||||||||
| NPI: | 1104852292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMAKER | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 S CLIFF AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640557015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164781230 | ||||||||
| FaxNumber: | 8164784413 | ||||||||
| Practice Location | |||||||||
| Address1: | 1613 S 7 HWY | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640143946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164781230 | ||||||||
| FaxNumber: | 8164784413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 12/04/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 2007010850 | MO | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | P00411373 | 01 | RAILROAD MEDICARE | OTHER |