Provider Demographics
NPI:1447285028
Name:HAMADA, BRONSON W (OD)
Entity type:Individual
Prefix:DR
First Name:BRONSON
Middle Name:W
Last Name:HAMADA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7192 EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3505
Mailing Address - Country:US
Mailing Address - Phone:714-848-1400
Mailing Address - Fax:714-848-5198
Practice Address - Street 1:7192 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3505
Practice Address - Country:US
Practice Address - Phone:714-848-1400
Practice Address - Fax:714-848-5198
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9003T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP9003AMedicare PIN
CA32548Medicare UPIN