Provider Demographics
NPI:1871763607
Name:DEMETRA HAMAKIOTES LLC
Entity type:Organization
Organization Name:DEMETRA HAMAKIOTES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMAKIOTES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-717-1500
Mailing Address - Street 1:171 E 84TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2000
Mailing Address - Country:US
Mailing Address - Phone:212-717-1500
Mailing Address - Fax:212-717-1482
Practice Address - Street 1:171 E 84TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2000
Practice Address - Country:US
Practice Address - Phone:212-717-1500
Practice Address - Fax:212-717-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005198152WC0802X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU30114Medicare UPIN
NY1324860001Medicare NSC