Individual
DR. KEITH R. HAMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3248 GREEN MOUNT CROSSING DR, SHILOH, IL 62269-7284
(618) 622-9225
(618) 624-6731
Mailing address
40 E NORTH ST, EUREKA, MO 63025-1205
(636) 200-4393
(636) 938-2650
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009444
IL
152W00000X
Optometrist
20020153161
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046-009444
—
IL
05
—
046-009444
—
MO
01
—
166472
BLUE CROSS BLUE SHIELD
—
01
—
238288
GHP
—
01
—
30821
MED COMPLETE
—
01
—
612276
HEALTHLINK
—
01
—
94444
EYEMED
—
01
—
P00238170
RAILROAD MEDICARE
IL
Enumeration date
09/14/2005
Last updated
08/17/2022
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