Provider Demographics
NPI:1689856247
Name:BRUCE L HAMMONDS OD PC
Entity Type:Organization
Organization Name:BRUCE L HAMMONDS OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-769-4404
Mailing Address - Street 1:2281 HOG MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4846
Mailing Address - Country:US
Mailing Address - Phone:706-769-4404
Mailing Address - Fax:706-769-0687
Practice Address - Street 1:2281 HOG MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4846
Practice Address - Country:US
Practice Address - Phone:706-769-4404
Practice Address - Fax:706-769-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000249301AMedicaid
GA1689856247OtherNPI ORGANIZATION
GAP00477530OtherMEDICARE RAILROAD RETIREMENT
GA41ZCCGWMedicare PIN
GA1689856247OtherNPI ORGANIZATION
GA000249301AMedicaid
GA0578800001Medicare NSC