Provider Demographics
NPI:1598020422
Name:HAMMOND, JOSEPH MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
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 1:2110 S HURSTBOURNE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1622
Mailing Address - Country:US
Mailing Address - Phone:502-491-2232
Mailing Address - Fax:502-499-2700
Practice Address - Street 1:4000 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1524
Practice Address - Country:US
Practice Address - Phone:502-459-2020
Practice Address - Fax:502-456-9121
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003736A152W00000X
KY1887DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100235340Medicaid
KY000000794382OtherANTHEM BCBS
KY1887DTOtherOPTOMETRIC LICENSE
IN18003736AOtherOPTOMETRIC LICENSE
IN18003736BOtherOPTOMETRIC LEGEND DRUG CERTIFICATE
KYP01252794OtherRR MEDICARE
KY5419240002Medicare NSC
KY000000794382OtherANTHEM BCBS
IN18003736BOtherOPTOMETRIC LEGEND DRUG CERTIFICATE
KYP01252794OtherRR MEDICARE