Basic Information
| Provider Information | |||||||||
| NPI: | 1649256512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAMMAR | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9000 W WISCONSIN AVE | ||||||||
| Address2: | PEDIATRIC OPHTHALMOLOGY | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146075280 | ||||||||
| FaxNumber: | 4142662027 | ||||||||
| Practice Location | |||||||||
| Address1: | 9000 W WISCONSIN AVE | ||||||||
| Address2: | PEDIATRIC OPHTHALMOLOGY | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146075280 | ||||||||
| FaxNumber: | 4142662027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1202X | IL | N | Eye and Vision Services Providers | Technician/Technologist | Optometric Technician | 207W00000X | 01058559A | IN | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 036107142 | IL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 63552 | WI | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 200871680B | 01 | IN | MEDICAID LOCATION CHICAGO RIDGE | OTHER | 036107142 | 05 | IL | MEDICAID | 200815870 | 01 | IN | MEDICARE LEGACY PROVIDER NUMBER | OTHER | 200871680A | 01 | IN | MEDICAID LOCATION MUNSTER | OTHER | 253350 | 01 | IN | PTAN MEDICARE GROUP PRACTICE | OTHER | P00932398 | 01 | IL | MEDICARE RAILROAD DUPAGE CO INDIVIDUAL PTAN | OTHER | 180046209 | 01 | IL | MEDICARE RAILROAD | OTHER | DR4230 | 01 | IL | MEDICARE RAILROAD DUPAGE CO GROUP PTAN | OTHER | 01621679 | 01 | IL | BC/BS OF IL | OTHER | 1649256512 | 05 | WI | MEDICAID | 200871680C | 01 | IN | MEDICAID LOCATION ORLAND PARK | OTHER | 1083684922 | 01 | IL | GROUP NPI | OTHER | 200871680D | 01 | IN | MEDICAID LOCATION HINSDALE | OTHER | 205785 | 01 | IL | PTAN MEDICARE COOK COUNTY IL | OTHER | 205786 | 01 | IL | MEDICARE DUPAGE CO GRP PTAN | OTHER |