Provider Demographics
NPI:1265475156
Name:HAMMOND, PHILLIP R (OD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:R
Last Name:HAMMOND
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 1:232 JACKSON MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1425
Mailing Address - Country:US
Mailing Address - Phone:615-889-2274
Mailing Address - Fax:615-889-2257
Practice Address - Street 1:232 JACKSON MEADOWS DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1425
Practice Address - Country:US
Practice Address - Phone:615-889-2274
Practice Address - Fax:615-889-2257
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT 918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2242062OtherUNITED HEALTH CARE
TN3595332Medicaid
TN410005739OtherRAILROAD MEDICARE
TN0030700OtherBCBS
TN621180129OtherAETNA
TN11523404OtherCIGNA
TN3595332OtherMEDICARE PTAN
TN621180129OtherAETNA
TN3595332Medicaid