Provider Demographics
NPI:1083822829
Name:GAMMON, VICTORIA (OD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:GAMMON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1310
Mailing Address - Country:US
Mailing Address - Phone:631-734-6106
Mailing Address - Fax:
Practice Address - Street 1:4 SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2290
Practice Address - Country:US
Practice Address - Phone:631-728-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist