1609975846 NPI number — DR. EDMOND ROGER HAKIM O.D.

Table of content: DR. EDMOND ROGER HAKIM O.D. (NPI 1609975846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609975846 NPI number — DR. EDMOND ROGER HAKIM O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAKIM
Provider First Name:
EDMOND
Provider Middle Name:
ROGER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609975846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
254 NORTON AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
BARBERTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44203-1932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-753-2004
Provider Business Mailing Address Fax Number:
330-753-2004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254 NORTON AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBERTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44203-1932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-753-2004
Provider Business Practice Location Address Fax Number:
330-753-2004
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3802 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 003802-T842 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: 3802-T842 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: 3802-T842 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: 3802-T842 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , with the licence number: 3802-T842 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 3802-T842 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0595020 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1632590400 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34-1531581 . This is a "SUMMA HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341531581-001 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000133457 . This is a "OHIO BC BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: Q015690 . This is a "HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1609975846 . This is a "OPTOMETRIC SERVICES" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1609975846 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34-1531581 . This is a "HOMETOWN HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000166347 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2200596 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000133457 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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